KIN 2236 FINAL EXAM || WITH ACCURATE ANSWERS
100%.
the achilles tendon correct answers the tendons of the gastrocnemius and soleus fuse to become
one tendon, about 5 to 6 cm proximal to the calcaneal insertion, usually 50/50 form gastroc and
soleus
-the thickest and strongest tendon in the body
-this tendon has no synovial sheath but is surrounded by paratendon, which wraps around it and
receives blood flow
-so it is a vascular tendon bc it is surrounded by paratenon
where is the retrocalcaneal bursa correct answers this is proximal to the achilles tendon insertion
to the calcaneus, between the tendon and the calcaneus
-this can be pinched
what could the cause of posterior heel pain correct answers -could be achilles tendonitis, achilles
bursitis, or retrocalcaneal bursitis
-we need to look exactly where the pain is
-true tendon pain is only directly on the tendon, not around it
Retrocalcaneal Bursitis correct answers this is a fluid filled sac that stops the achilles tendon
from rubbing across bone
-this bursa is between the anterior inferior side of the achilles tendon and the posteriorsuperior
aspect of the calcaneus
-this is sometimes seen w insertional tendinopathy, so an issue w the tendon causes bursa to get
irritated
- structural irritants too so tight or pokey
-pain will be just above the insertion of achilles, but not directly on tendon
-pain with squeeze from side and behind tendon
achilles bursitis (superficial calcaneal bursitis) correct answers -aka the subcutaneous bursa
-the bursa is located between the calcaneal prominence or achilles tendon and the skin, so at
bottom of achilles
-pain w posterior aspect of heel w solid swelling, so pain below achilles
-this is often due to excessive friction or by wearing shoes that are too tight or too large
-there will be swelling, but wont be soft
management of an "itis" in posterior heel correct answers -this is when there is inflammation
-do POLICE/PEACE and LOVE
-address training and equipement issue
-we want to calm down swelling
-Heel lift takes pressure off achilles
-pad around pain w a donut so there is no pressure directly on bursda
-stretch achilles by stretching gastroc and soleus
,what is tendinotis or paratendinitis in ankle correct answers -tendinitis is inflammation of tendon,
this is pretty rare, from gastroc, soleus or other muscle in ankle
-paratendonitis is inflammation, pain, and crepitattion of the paratendon as it slides over the
structure (creeking noise and feel)
-this is a acute irritation, so too much too soon (increase FITT, not enough rest)
what are the internal and external factors that contribute to tendonitis and paratenonitis in ankle
correct answers -externla factors like rub from shoe, running down hill (tibialis anterior bc has to
pronate in plantarflexion so added stress) ,rubbing form laces in tibilais anterior, ot
hyperdorsiflexion (achilles from running uphill)
-internal factors could be foot malalignment, so improper rub over bone, cavus or flat/pronating
feet
what are signs and symptoms of tendonitis or paratenonitis in ankle correct answers -there is pain
and/or crepitation of paratenon of acute onset
-red and hot over involved structure
-usually preciptated by movement around ankle movement that was too much, too soon
-the diagnosis is made on the basis of local swelling
-look at STTT
-there will be pain on palpation only over the direct tendon
what is the usually rehab for ankle paratenonitis correct answers inflammatory phase:
POLICE/PEACE and LOVE, use heel lift, pad, support
-repair phase: heat to increase blood flow, idealize ROM, so stretch gastroc and soleus
-start strength and proprioception ex as able, could also do balance exercise
-address the training issues
-remodeling phase: idealize strength and do soft tissue work to realign fibres
-begin speed and power training
what is achilles tendinosis correct answers -this is chronic pathological changes brought by
repetitive micro trauma
-inflammatory cells are absent
-characteristic changes in collagen fibre structure, so fibres start to fray
-abnormal (poor) vascularity, so not getting good blood flow
-usually in midportion of of achille
what is the normal cause of achilles tendinosis correct answers -most often pain on achilles is
from tendinosis
-predisposing factors include:
-years of running
-excessive pronation, bc this causes increased load on gastroc and soleus to resupinate, achilles
gets twisted )
-poor flexibility
-training in cold climate since tissue is less flexible so more stress on it
-improper footwear
-may be brought about due to neglect of acute tendinitis
,-worsens w increase in FITT and insufficient recovery
what is the normal diagnosis of achilles tendinosis correct answers -history of FITT, pain that is
2-7 cm from insertion on calcaneus
-there is some swelling and tenderness over large portion of tendon
-faulty biomechanics
-on STTT, both plantar and dorsiflexion cause pain and crepitus, especially w loading
-nodules or bumps may be palpable
-also can see thickening of achilles bc it is frayed
what is the normal treatment of a tendinosis correct answers -starting in stage 2
-the goals are to idealize ROM, want tissue to be viable again, so use heat to improve vascularity
and figure out training problem
-eccentric strenghening program provide 60-90% improvement in pain and function for
tendinosis
so use both legs to get up on step, then eccentrically strengthen by lowing heel down, this is
painful bc tearing out injured fibres
-can do straight and bent for gastric and soleus
-do NOT use NSAIDS
what are risk factors, and symptoms of an achilles fracture correct answers -achilles is most
commonly ruptured tendon
-risk factors are males (10:1), use of steroids. prior rupture on the other side
-patient would report pop or snap like someone kicked them
-pain is immediate then rapidly subsides bc no longer attached, so hard to walk now
-pain is only at site of tear
-clinical signs are a palpable gap, positive thompson test and dorsiflexion when relaxed
explain inspection of achilles rupture and the thompson's test correct answers the foot hangs
straight down, there is no plantar flexion
-there is a palpable divot 1-2 inch above insertion, bc it is no linger attached to calcaneus
-unable to plantarflex, loose on stretch
-may have bruisinh and redness
-the thomspon test is hwne the calf muscle is squeezed, the foot should go up a bit bc tension on
achilles
-so a positive test is NO MOVEMENT bc achilles is ruptures
-can perform surgery or put in boot
what is the tibiofemoral joint correct answers -this is the articulating surface between medial and
lateral condyles of femur and tibia
-this joint allows transmission of body weight from the femur to the tibia while providing hinge
like, sagittal plane movement w a bit of tibial axial rotation
-so have flexion and extension, and a bit of rotation in screw home mech
, what are the two joints of the knee and the 3 articulating surfaces correct answers -the
tibiofemoral joint has two articulating surfaces: the medial and lateral condyles of the femur and
the tibia
-the patellofemoral joint is between patella and femur
what is the patellofemoral joint correct answers this is the articulation between the patella and
the femur
-the patella moves up and down through notched in the femur
-the patella is the largest sesamoid bone in the body
-the quad tendon comes down and attaches to patella, this gives mechanical advantage for
extension
-this is referred to as extensor mechanism
-also works eccentrically during gait to help us take weight and slowly bend the knee
explain the screw home mechanism correct answers -rotation occurs during the last few degrees
of extension because the medial femoral condyle is larger than lateral
-if foot is planted, the femur rotated medially
-if femur is fixed, the tibia rotated laterally
-this locks the joint to increase stability, regulated patella alignment
-the popliteus must then contract to externally rotate the femur on the tibia to unlock the knee
when is the knee the most stable and how does it gain stability correct answers the knee is most
stable in extension bc there is help from dynamic stabilizers and more bony fit
-knees have relatively poor bony fit when relaxed
-knee has strong fibrous joint capsule
-but knee also needs to relay on other structures for stability like MCL, LCL, ACL, PCL,
muscles
explain the capsule of the knee correct answers -the knee is surrounded by a capsule, anteriorly
to suprapatellar pouch and inferiorly to infrapatella fat pad and bursa
-medially it communicates w the deep fibres of MCL
-posteriorly it covers the femoral condyles
-the capsule is also lined by synovial membranes, except posteriorly where it passes in front of
cruciates
explain the three layers of the lateral support complex in the knee correct answers 1. there is
superficial layer, which is the illiotibial band and biceps femoris that gives support
2. middle layer, which holds the paterlla in place
-the patellofemoral ligaments and retinaculum(inert band of tissue that holds patella)
3. Deep layer, which has the Lateral collateral ligament (LCL), the popliteus, the capsule, and
other ligaments like arcuate and fabelofibular
explain how the lateral portion of the knee is supported by muscles correct answers -the biceps
femoris (part of hamstring)
-IT band, which helps stabilize outside of the leg when straight
-popliteus tendon which helps in screw home mech
