Leg Injuries

Leg Injuries

1. In the injuries of athletes the leg is the fourth most involved

   • It involves the calf musculature and achilles tendon
     • Two acute injuries involve the same unit musculotendinous
     • A tension of the gastrocnemius has few medical consequences
     • Achilles tendon rupture is painless but involves 6 months of rehabilitation

2. Gastrocnemius Strain (Tennis Leg)

   • is a tension that involves the musculotendinous union
     • medial head of the gastrocnemius and achilles tendon
     • higher frequency in athletes over 30 years and women
       • Not only in tennis is this problem but in a variety of activities
         • includes walks, basketball and various forms of dance
         • if it is not recognized or handled inappropriately it can cause disability months
           • is mistakenly diagnosed as plantar rupture
   • History
     • Mechanism Of Injury
       • is generated by a powerful propulsion movement ankle plantar flexion
         • associated with muscle fatigue
           • the injury follows a bout of achilles tendinitis or an ankle injury or sprain
           • the injury occurs in two parts
             • a minor strain that is ignored, followed minutes later by complete rupture
     • Symptoms
       • The athlete feels or hears a pop in the medial appear of the calf
       • feels like he has hit his calf with a tennis ball or racket
       • a spasm of the calf musculature occurs rapidly
       • swelling and ecchymosis not apparent the first hours of the injury
         • ecchymosis may appear distally around the ankle and even on the foot
       • 24 to 48 hours to induce the patient to seek medical attention
   • Physical Examination
     • tenderness towards the medial side of the muscle-tendon calf junction
       • Swelling and ecchymosis are present distal to the site of injury
         • Motion is limited, and the foot is held in plantar flexion
           • it possible to palpate a defect in the muscle , but the defect fills rapidly with blood
   • Radiographic Examination
     • radiographic study is not required
   • Treatment
     • Inicial Treatment
       • The ankle should be placed at a neutral angle and should be maintained with a splint
         • stay with repeated ice and focal compression
           • the efforts to recover the movement of the ankle
       • force the athlete to walk although gentle and active stretching is important
         • Oral administration of anti-inflammatory medications should be started inmediately
     • Definitive
       • the objectives is the recovery of normal strength and flexibility of the musculature
         • Three to five daily physiotherapy sessions to improve movement return
           • high intensity galvanic stimulation ice, active and passive stretching
             • Crutches without weight support and compression first 24 hours to calm bleeding
       • strengthening with theraband 3 sets of 10 repetitions
         • use a compression bandage
       • It is employed after removal of the cast
   • Other Diagnostic Test
     • It is nor necessary

3. Achilles Tendon Strain (Rupture)

   • Usually occurs in an abrupt, dramatic fashion
     • orthopedic surgeon, and analyze the treatment of injury
   • Hystory
     • Mechanism of Injury
       • Push-off with the forefoot (Forceful plantar flexion of the ankle )
         • Basketball, racquetball, softball, and tennis are sports most often associated with the injury
         • The injury often occurs at a time of relative fatigue
           • usually occur in athletes older than 30 years
             • Is less common in women
     • Symptoms
       • sensation of being struck in the region of the tendon
       • This usually accompanied by an audible pop or snap
   • Physical Examination
     • lack of reflex plantar flexion when the calf is sharply squeezed
       • A positive Thompson test
     • Substantial loss of strength in plantar flexion
     • Careful palpation usually reveals gap or loss of continuity in the tendon
     • Bleending and swelling may be substantial in 24 to 48 hours
     • Gait is antalgic and apropulsive
   • Radiographic Examination
     • is not indicated
   • Other Diagnostic Test
     • Magnetic resonance imaging may be useful to demonstrate the extent and exact location
   • Treatment
     • Definitive
       • Treatment should be left to the treating orthopedist
       • the patient will be immobilized in a cast or orthopedic device for 2 to 3 months
     • Initial
       • should be placed in a compression wrap
       • the ankle should be in a position of gravity- assisted plantar flexion
       • a posterior plaster splint compression dressing helps maintain the plantarflexed

4. Acute Compartment Syndromes

   • condition in which inside a osteofascial compartment they are compromised by the pressure
     • 4 compartements in the leg, the anterior is by far the most commonly involved
   • History
     • Mechanism of Injury
       • Any macrotrauma or microtrauma including
         • fractures
         • Tendon ruptures
         • Muscle strains
         • Contusions
         • associated with bleeding or edema formation within
     • Symptoms
       • Severe pain
       • Paresthesias
   • Physical Examination
     • Swelling and tendernessover the compartment are early signs
     • Paresis, pallor and pulselessness are late and ominous signs
   • Diagnostic Tests
     • direct measurement of intracompartmental pressure
   • Treatment
     • Initial
       • mainly of rest and the application of ice
         • Compression is contraindicated
           • Elevation is also probably contraindicated
     • Definitive
       • Multiple compartment syndrome may be treated by proximal fibulectomy

5. Achilles Tendinitis

   • Inflammation of the Achilles tendon and even predispose to later rupture
     • this condition is twofold
       • The injury often seen only when it has become chronic
       • The rehabilitation is a time-consuming and frustrating process
       • The pathoanatomy includes of chronically inflamed partial rupture
         • Stenosis and calcification within the tendon
   • History
     • Mechanism of Injury
       • Result of too much of an unaccustomed activity
         • Hill running and changing of heel height
       • Result of direct trauma such a pressure from the top of the heel counter of a shoe
       • High-arched foot, a flat or pronated foot or a tight achilles tendon
     • Symptoms
       • Pain and stiffness are the usual initial complaints
       • The athlete notices the presence of crepitation often of the squeaking or snowball type
   • Physical Examination
     • Palpation or squeezing the tendon produces tenderness
     • passively dorsiflexing the ankle with the knee extended often produces pain
     • A diffusely, grossly enlarged, dense, tender tendon usually indicated the presence of peritendinous fibrosis and scarring
   • Radiographic Examination
     • In chonic cases a lateral view of the leg
       • May reveral the presence of calcification or ossification within the tendon
   • Other Diagnostic Tests
     • A radionuclide bone scan reveals whether the process is still active
       • MRI, and to a lesser degree sonography
   • Treatment
     • Initial
       • Total cessation of weight load
         • heel elevation, non-steroidal anti-inflammatory drugs and repeated application of ice
           • sleep at right angles
             • high intensity galvanic stimulation, ultrasonography, cryotherapy and even cyriax massage
     • Definitive
       • Stretching exercises should be done repeatedly throughout the day and strengthening
         • painless range of motion

6. Chronic Anterior Leg Pain (Shin Splints)

   • pain between knee and ankle
     • not involving the calf/ achilles tendon
   • History
     • Mechanism of Injury
       • Result of unaccustomed activity or overuse
         • Biomechanical abnormalities, such as hyperpronation of the foot
     • Symptoms
       • The primary symptom for all these conditions is pain
         • Pain in the distal lateral aspect of the leg often indicates a fibular stress fracture
           • Pain in the entire anterior lateral area of the leg may indicate presence of a chronic compartment syndrome
             • Pain over the anterior surface of the tibia in the midleg indicated a tibial stress fracture
         • Diffuse swelling, often described as a tense sensation
           • Paresthesia or hypesthesia
   • Physical Examination
     • tenderness over either the tibia or the fibula
       • Muscle testing is helpful in some conditions
         • Careful palpation of the anterior compartment may reveal incresed tightness
           • The presence of a high-arched foot, or signficant pronation
   • Radiographic Examination
     • Anteroposterior and lateral radiographs of the lef often reveal stress fractures
   • Other diagnostics tests
     • Radionuclide bone scanning
   • Treatment
     • Initial
       • interruption of activities that produce pain
         • wandering without crutches
           • use modalities such as icing, ultrasonography and high intensity galvanic
     • Definitive
       • Stretching and strengthening exercises
         • Arch Supports
           • Band or counterforce bracing

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