15
1 1 Unraveling the Mystery of Ankle Pain #3: Posterior and Retinaculum Ligament Sprains Unraveling the Mystery of Ankle Pain #3: Posterior and Retinaculum Ligament Sprains Instructor: Ben Benjamin, Ph.D. Instructor: Ben Benjamin, Ph.D. 2 Instructor: Ben Benjamin, Ph.D. Instructor: Ben Benjamin, Ph.D. 3

Posterior and Retinaculum Ligament Sprains - Ben …benbenjamin.com/webinars/Ankle 3 Notes.pdf · Posterior and Retinaculum Ligament Sprains ... the ankle joint in place 5. ... Ankle

  • Upload
    dothuy

  • View
    226

  • Download
    0

Embed Size (px)

Citation preview

Page 1: Posterior and Retinaculum Ligament Sprains - Ben …benbenjamin.com/webinars/Ankle 3 Notes.pdf · Posterior and Retinaculum Ligament Sprains ... the ankle joint in place 5. ... Ankle

1

1

Unraveling the Mystery of Ankle Pain #3:

Posterior and Retinaculum Ligament Sprains

Unraveling the Mystery of Ankle Pain #3:

Posterior and Retinaculum Ligament Sprains

Instructor: Ben Benjamin, Ph.D.Instructor: Ben Benjamin, Ph.D.

2

Instructor: Ben Benjamin, Ph.D.Instructor: Ben Benjamin, Ph.D.

3

Page 2: Posterior and Retinaculum Ligament Sprains - Ben …benbenjamin.com/webinars/Ankle 3 Notes.pdf · Posterior and Retinaculum Ligament Sprains ... the ankle joint in place 5. ... Ankle

2

Webinar GoalsWebinar Goals

• Explore the Assessment and Treatment of Posterior and Retinaculum Ankle Ligament Sprains

• Explore the Assessment and Treatment of Posterior and Retinaculum Ankle Ligament Sprains

4

LogisticsLogistics• Time: 60 minutes

• Schedule:

• Presentation 30-40 minutes

• Questions 15–20 minutes

• Ongoing questions: Use Question box.If I don’t get to your question, ask me on my Dr Ben Benjamin Facebook page after the webinar.

• Get a pen and paper please

• Time: 60 minutes

• Schedule:

• Presentation 30-40 minutes

• Questions 15–20 minutes

• Ongoing questions: Use Question box.If I don’t get to your question, ask me on my Dr Ben Benjamin Facebook page after the webinar.

• Get a pen and paper please

5

6

PretestPretest1. Pain behind the ankle on the posterior lateral aspect indicates a: a.)

calcaneofibular ligament injury, b.) fibularis tendon or tibialis posterior injury, c.) posterior talofibular ligament injury, or d.) tibialis posterior tendon injury

2. The posterior talofibular ligament: a.) doesn’t have an effective assessment test, b.) never gets injured, c.) doesn’t connect any bones, or d.) is connected to the anterior talofibular ligament

3. Posterior ligament sprains are: a.) the least common of the lateral ligament sprains, b.) the most common of the lateral ligament sprains, c.) more common than calcaneofibular ligament sprains, or d.) easy to detect

4. The cruciate crural ligament or retinaculum holds: a.) the nerves of the foot in place, b.) the flexor hallucis in place, c.) many of the extensor tendons of the foot in place, or d.) the ankle joint in place

5. How many cruciate crural ligaments are there? a.) Five, b.) Three, c.) Two, or d.) Six

6. The retinaculum is often injured along with: a.) a deltoid ligament, b.) a cuboid ligament, c.) a medial ankle sprain or with falling, or d.) a lateral ankle sprain or with something heavy dropped on the foot

Page 3: Posterior and Retinaculum Ligament Sprains - Ben …benbenjamin.com/webinars/Ankle 3 Notes.pdf · Posterior and Retinaculum Ligament Sprains ... the ankle joint in place 5. ... Ankle

3

AnatomyAnatomy

7

The Posterior Talofibular Ligaments The Posterior Talofibular Ligaments

8

The Primary Ankle LigamentsThe Primary Ankle Ligaments

9

Page 4: Posterior and Retinaculum Ligament Sprains - Ben …benbenjamin.com/webinars/Ankle 3 Notes.pdf · Posterior and Retinaculum Ligament Sprains ... the ankle joint in place 5. ... Ankle

4

AssessmentPosterior Talofibular Ligament

AssessmentPosterior Talofibular Ligament

10

Assessment History and Tests for thePosterior Talofibular Ligament

Assessment History and Tests for thePosterior Talofibular Ligament

11

1. Posterior Palpation in Dorsiflexion

2. Passive dorsiflexion

3. Passive plantarflexion

4. Heat test

5. Heel raises

Finding the Posterior Talofibular LigamentFinding the Posterior Talofibular Ligament

12

Page 5: Posterior and Retinaculum Ligament Sprains - Ben …benbenjamin.com/webinars/Ankle 3 Notes.pdf · Posterior and Retinaculum Ligament Sprains ... the ankle joint in place 5. ... Ankle

5

Posterior Palpation in DorsiflexionPosterior Palpation in Dorsiflexion

13

Passive Dorsiflexion Passive Dorsiflexion

14

Passive Plantar FlexionPassive Plantar Flexion

15

Page 6: Posterior and Retinaculum Ligament Sprains - Ben …benbenjamin.com/webinars/Ankle 3 Notes.pdf · Posterior and Retinaculum Ligament Sprains ... the ankle joint in place 5. ... Ankle

6

Heat TestHeat Test

16

Achilles Tendon Differentiation

Achilles Tendon Differentiation

17

Alignment CheckAlignment Check

18

Page 7: Posterior and Retinaculum Ligament Sprains - Ben …benbenjamin.com/webinars/Ankle 3 Notes.pdf · Posterior and Retinaculum Ligament Sprains ... the ankle joint in place 5. ... Ankle

7

Assessment Tests Extensor Retinaculum/Cruciate Crural Ligament

Assessment Tests Extensor Retinaculum/Cruciate Crural Ligament

19

Four Toe Resisted Extension Four Toe Resisted Extension

20

Four Toe Resisted Extensionwith Palpation

Four Toe Resisted Extensionwith Palpation

21

Page 8: Posterior and Retinaculum Ligament Sprains - Ben …benbenjamin.com/webinars/Ankle 3 Notes.pdf · Posterior and Retinaculum Ligament Sprains ... the ankle joint in place 5. ... Ankle

8

TheoryTheory

22

Posterior Talofibular Ligament SprainPositive Tests

Posterior Talofibular Ligament SprainPositive Tests

MI: Posterior Palpation in Dorsiflexion

AUX: Passive Dorsiflexion of the ankle is painful and often limited

AUX: Passive Plantarflexion of the ankle is painful and often limited

AUX: Heat Test is positive. The injured ankle is often hot or at least warmer then the other one

23

24

Posterior Talofibular LigamentPosterior Talofibular Ligament

Page 9: Posterior and Retinaculum Ligament Sprains - Ben …benbenjamin.com/webinars/Ankle 3 Notes.pdf · Posterior and Retinaculum Ligament Sprains ... the ankle joint in place 5. ... Ankle

9

Posterior Ankle SprainsPosterior Ankle Sprains

25

Persistent SwellingPersistent Swelling

What to watch out for confusionWhat to watch out for confusion

27

Fibularis Tendon

Page 10: Posterior and Retinaculum Ligament Sprains - Ben …benbenjamin.com/webinars/Ankle 3 Notes.pdf · Posterior and Retinaculum Ligament Sprains ... the ankle joint in place 5. ... Ankle

10

Persistent SwellingPersistent Swelling

TreatmentTreatment

30

Page 11: Posterior and Retinaculum Ligament Sprains - Ben …benbenjamin.com/webinars/Ankle 3 Notes.pdf · Posterior and Retinaculum Ligament Sprains ... the ankle joint in place 5. ... Ankle

11

Friction TherapyFriction Therapy

31

Posterior Talofibular Ligament FrictionPosterior Talofibular Ligament Friction

Friction Therapy of Crucial Crural LigamentFriction Therapy of Crucial Crural Ligament

32Extensor Retinaculum Ligament FrictionExtensor Retinaculum Ligament Friction

Myofascial TherapyMyofascial Therapy

33

Page 12: Posterior and Retinaculum Ligament Sprains - Ben …benbenjamin.com/webinars/Ankle 3 Notes.pdf · Posterior and Retinaculum Ligament Sprains ... the ankle joint in place 5. ... Ankle

12

Massage TherapyMassage Therapy

34

Exercise TherapyExercise Therapy

35

Exercise TherapyExercise Therapy

36

Page 13: Posterior and Retinaculum Ligament Sprains - Ben …benbenjamin.com/webinars/Ankle 3 Notes.pdf · Posterior and Retinaculum Ligament Sprains ... the ankle joint in place 5. ... Ankle

13

Exercise TherapyExercise Therapy

37

Exercise TherapyExercise Therapy

38

Exercise TherapyExercise Therapy

39

Page 14: Posterior and Retinaculum Ligament Sprains - Ben …benbenjamin.com/webinars/Ankle 3 Notes.pdf · Posterior and Retinaculum Ligament Sprains ... the ankle joint in place 5. ... Ankle

14

Exercise TherapyExercise Therapy

40

Exercise TherapyExercise Therapy

41

Exercise TherapyExercise Therapy

42

Anterior Stretch

Medial Stretch Lateral Stretch

Page 15: Posterior and Retinaculum Ligament Sprains - Ben …benbenjamin.com/webinars/Ankle 3 Notes.pdf · Posterior and Retinaculum Ligament Sprains ... the ankle joint in place 5. ... Ankle

15

QuestionsQuestions

43

Facebook.com/DrBenBenjaminFacebook.com/DrBenBenjamin

44

Post-testPost-test1. Pain behind the ankle on the posterior lateral aspect indicates a: a.)

calcaneofibular ligament injury, b.) fibularis tendon or tibialis posterior injury, c.) posterior talofibular ligament injury, or d.) tibialis posterior tendon injury

2. The posterior talofibular ligament: a.) doesn’t have an effective assessment test, b.) never gets injured, c.) doesn’t connect any bones, or d.) is connected to the anterior talofibular ligament

3. Posterior ligament sprains are: a.) the least common of the lateral ligament sprains, b.) the most common of the lateral ligament sprains, c.) more common than calcaneofibular ligament sprains, or d.) easy to detect

4. The cruciate crural ligament or retinaculum holds: a.) the nerves of the foot in place, b.) the flexor hallucis in place, c.) many of the extensor tendons of the foot in place, or d.) the ankle joint in place

5. How many cruciate crural ligaments are there? a.) Five, b.) Three, c.) Two, or d.) Six

6. The retinaculum is often injured along with: a.) a deltoid ligament, b.) a cuboid ligament, c.) a medial ankle sprain or with falling, or d.) a lateral ankle sprain or with something heavy dropped on the foot