Question:

When you sprain your ankle, do you get a shooting pain up to your knee?

Answer:

Some signs of a sprained ankle: Swelling, due to increased fluid in the tissue, sometimes severe. The nerves are more sensitive. The joint hurts and may throb. The pain can worsen when the sore area is pressed or during walking or standing.

More Info:

A sprain is an injury in a joint, caused by the ligament being stretched beyond its own capacity. A muscular tear caused in the same manner is referred to as a strain. In cases where either ligament or muscle tissue is torn, immobilization and surgical repair may be necessary. Ligaments are tough, fibrous tissues that connect bones to other bones. Sprains can occur in any joint but are most common in the ankle and wrist. The diagnosis of a sprain injury is made by a physical examination. In most cases an x-ray (or stress x-ray) of the affected joint is obtained to ensure that there are no fractures. If a tear in the ligament is suspected, then an MRI or arthroscopy is obtained. MRI is usually ordered after swelling has subsided and can readily identify the presence of a ligament injury. Sprains typically occur when the joint is overextended. This can cause over stretching of the joints, tear or slipping of the ligament. Although any joint can experience a sprain, some of the more common include: There are certain factors which increase risk of sprains. Fatigue of muscles generally leads to sprains. When one suddenly starts to exercise after a sedentary lifestyle, sprains are quite common. While scientific studies are lacking, it is often thought that not warming-up is a common cause of sprains in athletes. Warming-up is thought to loosen the joint, increases blood flow and makes the joint more flexible. Diagnosis of sprains is not difficult but in most cases X-rays are obtained to ensure that there is no fracture. In many cases, if the injury is prolonged, magnetic resonance imaging (MRI) is performed to look at surrounding soft tissues and the ligament. The first modality for a sprain can be remembered using the acronym RICE. The treatment of sprains depends on the extent of injury and the joint involved. Medications like non-steroidal anti-inflammatory drugs can relieve pain. Weight bearing should be gradual and advanced as tolerated. Ice and compression (cold compression therapy) will not completely stop swelling and pain, but will help to minimize them as the sprain begins to heal itself. Careful management of swelling is critical to the healing process as additional fluid may pool in the sprained area. The joint should be exercised again fairly soon, in milder cases from 1 to 3 days after injury. Special exercises are sometimes needed in order to regain strength and help reduce the risk of ongoing problems. The joint may need to be supported by taping or bracing, helping protect it from re-injury. Prolonged immobilization delays the healing of a sprain, as it usually leads to muscle atrophy and stiff joint. The components of an effective rehabilitation for all sprain injuries include increasing range of motion and progressive muscle strengthening exercise. These should be taken care of without delay. M: JNT anat (h/c, u, t, l)/phys noco (arth/defr/back/soft)/cong, sysi/epon, injr proc, drug (M01C, M4) M: MUS, DF+DRCT anat (h/n, u, t/d, a/p, l)/phys/devp/hist noco (m, s, c)/cong (d)/tumr, sysi/epon, injr proc, drug (M1A/3)
The ankle, or talocrural region, is the region where the foot and the leg meet. The ankle includes three joints: the ankle joint proper or talocrural joint, the subtalar joint, and the Inferior tibiofibular joint. The movements produced at this joint are dorsiflexion and plantaflexion of the foot. In common usage, the term ankle refers exclusively to the ankle region. In medical terminology, "ankle" (without qualifiers) can refer broadly to the region or specifically to the talocrural joint. The main bones of the ankle region are the talus (in the foot), and the tibia and fibula (in the leg). The talus is also called the ankle bone. The talocrural joint, is a synovial hinge joint that connects the distal ends of the tibia and fibula in the lower limb with the proximal end of the talus. The articulation between the tibia and the talus bears more weight than between the smaller fibula and the talus. The word ankle or ancle is common, in various forms, to Germanic languages, probably connected in origin with the Latin "angulus", or Greek "αγκυλος", meaning bent. It has been suggested that dexterous control of toes has been lost in favour of a more precise voluntary control of the ankle joint. The boney architecture of the ankle consists of three bones: the tibia, the fibula, and the talus. The articular surface of the tibia is referred to as the plafond. The medial malleolus is a boney process extending distally off the medial tibia. The distal-most aspect of the fibula is called the lateral malleolus. Together, the malleoli, along with their supporting ligaments, stabilize the talus underneath the tibia. The boney arch formed by the tibial plafond and the two malleoli is referred to as the ankle "mortise" (or talar mortise). The mortise is a rectangular socket. The ankle is composed of three joints: the talocrural joint (also called tibiotalar joint, talar mortise, talar joint), the subtalar joint (also called talocalcaneal), and the Inferior tibiofibular joint. The joint surface of all bones in the ankle are covered with articular cartilage. The ankle joint is bound by the strong deltoid ligament and three lateral ligaments: the anterior talofibular ligament, the posterior talofibular ligament, and the calcaneofibular ligament. Though it does not span across the ankle joint itself, the syndesmotic ligament makes an important contribution to the stability of the ankle. This ligament spans the syndesmosis, which is the term for the articulation between the medial aspect of the distal fibula and the lateral aspect of the distal tibia. An isolated injury to this ligament is often called a high ankle sprain. The boney architecture of the ankle joint is most stable in dorsiflexion. Thus, a sprained ankle is more likely to occur when the ankle is plantar-flexed, as ligamentous support is more important in this position. The classic ankle sprain involves the anterior talofibular ligament (ATFL), which is also the most commonly injured ligament during inversion sprains. Another ligament that can be injured in a severe ankle sprain is the calcaneofibular ligament. Mechanoreceptors of the ankle send proprioceptive, sensory input to the central nervous system (CNS). Muscle spindles are thought to be the main type of mechanoreceptor responsible for proprioceptive attributes from the ankle. The muscle spindle gives feedback to the CNS system on the current length of the muscle it innervates and to any change in length that occurs. It was hypothesized that muscle spindle feedback from the ankle dorsiflexors played the most substantial role in proprioception relative to other muscular receptors that cross at the ankle joint. However, due to the multi-planar range of motion at the ankle joint there is not one group of muscles that is responsible for this. This helps to explain the relationship between the ankle and balance. In 2011, a relationship between proprioception of the ankle and balance performance was seen at in the CNS. This was done by using a fMRI machine in order to see the changes in brain activity when the receptors of the ankle are stimulated. This implicates the ankle directly with the ability to balance. Further research is needed in order to see to what extent does the ankle affect balance. Symptoms of an ankle fracture can be similar to those of ankle sprains (pain), though typically they are often more severe by comparison. It is exceedingly rare for the ankle joint to dislocate in the presence of ligamentous injury alone. The talus is most commonly fractured by two methods. The first is hyperdorsiflexion, where the neck of the talus is forced against the tibia and fractures. The second is jumping from a height - the body is fractured as the talus transmits the force from the foot to the lower limb bones. In the setting of an ankle fracture the talus can become unstable and subluxate or dislocate. People may complain of ecchymosis (bruising), or there may be an abnormal position, abnormal motion, or lack of motion. Diagnosis is typically by X-ray. Treatment is either via surgery or casting depending on the fracture types. Dorsum of Foot. Ankle joint. Deep dissection Dorsum of Foot. Ankle joint. Deep dissection Ankle joint. Deep dissection. Anterior view. Dorsum of Foot. Ankle joint. Deep dissection Media related to Ankle at Wikimedia Commons
M: JNT anat (h/c, u, t, l)/phys noco (arth/defr/back/soft)/cong, sysi/epon, injr proc, drug (M01C, M4)
A strain is an injury to a muscle or tendon] [ in which the muscle fibers tear as a result of overstretching. A strain is also colloquially known as a pulled muscle. The equivalent injury to a ligament is a sprain. Typical symptoms of a strain include localized stiffness, discoloration and bruising around the strained muscle. Strains are a result of muscular-fiber tears due to overstretching. They can happen while doing everyday tasks and are not restricted to athletes. Nevertheless, people who play sports are more at risk of developing a strain due to increased muscle.][ Strains may be very painful. The first-line treatment for a muscular strain in the acute phase include five steps commonly known as P.R.I.C.E. The ice and compression (cold compression therapy) will stop the pain and swelling while the injury starts to heal itself. Controlling the inflammation is critical to the healing process and the icing further restricts fluid leaking into the injured area as well as controlling pain. Cold compression therapy wraps are a useful way to combine icing and compression to stop swelling and pain. This immediate treatment is usually accompanied by the use of nonsteroidal anti-inflammatory drugs (e.g., ibuprofen), which both reduce the immediate inflammation and relieve pain. However, NSAIDs, including aspirin and ibuprofen, affect platelet function (this is why they are known as "blood thinners") and should not be taken during the period when tissue is bleeding because they will tend to increase blood flow, inhibit clotting, and thereby bleeding and swelling. After the bleeding has stopped, NSAIDs can be used with some effectiveness to reduce inflammation and pain. It is recommended that the person injured should consult a medical provider if the injury is accompanied by severe pain, if the limb cannot be used, or if there is noticeable tenderness over an isolated spot. These can be signs of a broken or fractured bone, a sprain, or a complete muscle tear. Therapeutic ultrasound can be used to break down poorly healed muscle strains and permit them to heal properly. M: JNT anat (h/c, u, t, l)/phys noco (arth/defr/back/soft)/cong, sysi/epon, injr proc, drug (M01C, M4) M: MUS, DF+DRCT anat (h/n, u, t/d, a/p, l)/phys/devp/hist noco (m, s, c)/cong (d)/tumr, sysi/epon, injr proc, drug (M1A/3)
In medical parlance, swelling, turgescence or tumefaction is a transient abnormal enlargement of a body part or area not caused by proliferation of cells. It is caused by accumulation of fluid in tissues. It can occur throughout the body (generalized), or a specific part or organ can be affected (localized). Swelling is considered one of the five characteristics of inflammation; along with pain, heat, redness, and loss of function. In a general sense, the suffix "-megaly" is used to indicate a growth, as in hepatomegaly, acromegaly, and splenomegaly. A body part may swell in response to injury, infection, or disease. Swelling, especially of the ankle, can occur if the body is not circulating fluid well. Generalized swelling, or massive edema (also called anasarca), is a common sign in severely ill people. Although slight edema may be difficult to detect to the untrained eye, especially in an overweight person, massive edema is very obvious. Congenital swellings are present since birth, e.g., hemangioma, meningocele, etc. Some congenital swellings may not appear since birth, but later in life, e.g., branchial cyst, dermatoid cyst, thyroglossal cyst. Traumatic swellings develop immediately after trauma, e.g., hematoma, dislocation. Inflammatory swelling: It may be either acute or chronic variety. The presentations of acute swellings are redness, local fever, pain and impairment of function of the affected organ. The related lymph nodes will be affected and will show signs of acute lymphadenitis. Chronic inflammatory swellings will show the signs of acute inflammatory swellings, but in subdued form. In this case, edema might not occur. Such swellings can be differentiated from neoplastic swellings by the fact that neoplastic swellings never recede in size, but inflammatory swellings may show occasional diminution. Causes of generalized swelling: Some possible causes of a swollen limb include: While it is possible for mild swelling to go away on its own, several things can be done to relieve the symptoms or hasten the process. The RICE first aid method of rest and protecting the affected area has long been taught as a short term solution. The application of oxygen is known to assist in the reduction of swelling. An effective option for extrinsic treatment of swelling and it's reduction is Kinesio Tape (KT). By strategically cutting and placing Kinesio Tape above the area of swelling it assists in the removal of edema (swelling) by directing the exudates toward lymphatic ducts. This is aided by KT's inherent property of lifting the epidermis away from the dermis creating a larger area for blood flow and lymphatic movement.][ M: INT, SF, LCT anat/phys/devp noco (i/b/d/q/u/r/p/m/k/v/f)/cong/tumr (n/e/d), sysi/epon proc, drug (D2/3/4/5/8/11) M: SKA anat/phys/devp noco/cong/tumr, sysi/epon proc, drug (D10)
Back pain is pain felt in the back that usually originates from the muscles, nerves, bones, joints or other structures in the spine. Back pain may have a sudden onset or can be a chronic pain; it can be constant or intermittent, stay in one place or radiate to other areas. It may be a dull ache, or a sharp or piercing or burning sensation. The pain may radiate into the arms and hands as well as the legs or feet, and may include symptoms other than pain. These symptoms may include tingling, weakness or numbness. Back pain is one of humanity's most frequent complaints. In the U.S., acute low back pain (also called lumbago) is the fifth most common reason for physician visits. About nine out of ten adults experience back pain at some point in their life, and five out of ten working adults have back pain every year. The spine is a complex interconnecting network of nerves, joints, muscles, tendons and ligaments, all of which are capable of producing pain. Large nerves that originate in the spine and go to the legs and arms can make pain radiate to the extremities. Back pain can be divided anatomically: neck pain, middle back pain, lower back pain or tailbone pain. By its duration: acute (up to 12 weeks), chronic (more than 12 weeks) and subacute (the second half of the acute period, 6 to12 weeks). By its cause: nonspecific back pain, back pain with radiculopathy or spinal stenosis, and back pain associated with another specific cause (such as infection or cancer). Non specific pain indicates that the cause is not known precisely but is believed to be due from the soft tissues such as muscles, fascia, and ligaments. Back pain is classified according to etiology in mechanical or nonspecific back pain and secondary back pain. Approximately 98% of back pain patients are diagnosed with nonspecific acute back pain which has no serious underlying pathology. However, secondary back pain which is caused by an underlying condition accounts for nearly 2% of the cases. Underlying pathology in these cases may include metastatic cancer, spinal osteomyelitis and epidural abscess which account for 1% of the patients. Also, herniated disc is the most common neurologic impairment which is associated with this condition, from which 95% of disc herniations occur at the lowest two lumbar intervertebral levels. Back pain does not usually require immediate medical intervention. The vast majority of episodes of back pain are self-limiting and non-progressive. Most back pain syndromes are due to inflammation, especially in the acute phase, which typically lasts from two weeks to three months. Back pain can be a sign of a serious medical problem, although this is not most frequently the underlying cause: A few observational studies suggest that two conditions to which back pain is often attributed, lumbar disc herniation and degenerative disc disease may not be more prevalent among those in pain than among the general population, and that the mechanisms by which these conditions might cause pain are not known. Other studies suggest that for as many as 85% of cases, no physiological cause can be shown. A few studies suggest that psychosocial factors such as on-the-job stress and dysfunctional family relationships may correlate more closely with back pain than structural abnormalities revealed in x-rays and other medical imaging scans. There are several potential sources and causes of back pain. However, the diagnosis of specific tissues of the spine as the cause of pain presents problems. This is because symptoms arising from different spinal tissues can feel very similar and is difficult to differentiate without the use of invasive diagnostic intervention procedures, such as local anesthetic blocks. One potential source of back pain is skeletal muscle of the back. Potential causes of pain in muscle tissue include muscle strains (pulled muscles), muscle spasm, and muscle imbalances. However, imaging studies do not support the notion of muscle tissue damage in many back pain cases, and the neurophysiology of muscle spasm and muscle imbalances is not well understood. Another potential source of lower back pain is the synovial joints of the spine (e.g. zygapophysial joints/facet joints. These have been identified as the primary source of the pain in approximately one third of people with chronic low back pain, and in most people with neck pain following whiplash. However, the cause of zygapophysial joint pain is not fully understood. Capsule tissue damage has been proposed in people with neck pain following whiplash. In people with spinal pain stemming from zygapophysial joints, one theory is that intra-articular tissue such as invaginations of their synovial membranes and fibro-adipose meniscoids (that usually act as a cushion to help the bones move over each other smoothly) may become displaced, pinched or trapped, and consequently give rise to nociception (pain). There are several common other potential sources and causes of back pain: these include spinal disc herniation and degenerative disc disease or isthmic spondylolisthesis, osteoarthritis (degenerative joint disease) and lumbar spinal stenosis, trauma, cancer, infection, fractures, and inflammatory disease. The anterior ligaments of the intervertebral disc are extremely sensitive, and even the slightest injury can cause significant pain. Radicular pain (sciatica) is distinguished from 'non-specific' back pain, and may be diagnosed without invasive diagnostic tests. New attention has been focused on non-discogenic back pain, where patients have normal or near-normal MRI and CT scans. One of the newer investigations looks into the role of the dorsal ramus in patients that have no radiographic abnormalities. See Posterior Rami Syndrome. In the most common cases of low back pain, professional organizations recommend that physicians not immediately seek a diagnosis but instead begin treatment to reduce pain. This assumes that the physician has no reason to expect that the patient has an underlying problem. In most cases, the pain goes away naturally after a few weeks. Research has shown that typical patients who do seek diagnosis through imaging are not likely to have a better outcome than patients who wait for the condition to resolve. In cases in which the back pain has a persistent underlying cause, such as a specific disease or spinal abnormality, then it is necessary for the physician to differentiate the source of the pain and advise specific courses of treatment. The management goals when treating back pain are to achieve maximal reduction in pain intensity as rapidly as possible; to restore the individual's ability to function in everyday activities; to help the patient cope with residual pain; to assess for side-effects of therapy; and to facilitate the patient's passage through the legal and socioeconomic impediments to recovery. For many, the goal is to keep the pain to a manageable level to progress with rehabilitation, which then can lead to long term pain relief. Also, for some people the goal is to use non-surgical therapies to manage the pain and avoid major surgery, while for others surgery may be the quickest way to feel better. Not all treatments work for all conditions or for all individuals with the same condition, and many find that they need to try several treatment options to determine what works best for them. The present stage of the condition (acute or chronic) is also a determining factor in the choice of treatment. Only a minority of back pain patients (most estimates are 1% - 10%) require surgery. Depending on the particular cause of the condition, posture training courses and physical exercises might help with relieving the pain. Surgery may sometimes be appropriate for patients with: Surgery is usually the last resort in the treatment of back pain. It is usually only recommended if all other treatment options have been tried or in an emergency situation. A 2009 systematic review of back surgery studies found that, for certain diagnoses, surgery is moderately better than other common treatments, but the benefits of surgery often decline in the long term. The main procedures used in back pain surgery are discetomies, spinal fusions, laminectomies, removal of tumors, and vertebroplasties. There are different types of surgical procedures that are used in treating various conditions causing back pain. Nerve decompression, fusion of body segments and deformity correction surgeries are examples. The first type of surgery is primarily performed in older patients who suffer from conditions causing nerve irritation or nerve damage. Fusion of bony segments is also referred to as a spinal fusion, and it is a procedure used to fuse together two or more bony fragments with the help of metalwork. The latter type of surgery is normally performed to correct congenital deformities or those that were caused by a traumatic fracture. In some cases, correction of deformities involves removing bony fragments or providing stability provision for the spine. A time-tested procedure to repair common intervertebral disc lesions which offers rapid recovery (just a few days) involves the simple removal of the fibrous nucleus of the affected intervertebral disc. Various techniques, such as in the following paragraph, are described in the literature. A discetomy is performed when the intervertebral disc have herniated or torn. It involves removing the protruding disc, either a portion of it or all of it, that is placing pressure on the nerve root. The disc material which is putting pressure on the nerve is removed through a small incision that is made over that particular disc. This is one of the most popular types of back surgeries and which also has a high rate of success. The recovery period after this procedure does not last longer than 6 weeks. The type of procedure in which the bony fragments are removed through an endoscope is called percutaneous disc removal. Microdiscetomies may be performed as a variation of standard discetomies in which a magnifier is used to provide the advantage of a smaller incision, thus a shorter recovery process. Spinal fusions are performed in cases in which the patient has had the entire disc removed or when another condition has caused the vertebrae to become unstable. The procedure consists in uniting two or more vertebrae by using bone grafts and metalwork to provide more strength for the healing bone. Recovery after spinal fusion may take up to one year, depending greatly on the age of the patient, the reason why surgery has been performed and how many bony segments needed to be fused. In cases of spinal stenosis or disc herniation, laminectomies can be performed to relieve the pressure on the nerves. During such a procedure, the surgeon enlarges the spinal canal by removing or trimming away the lamina which will provide more space for the nerves. The severity of the condition as well as the general health status of the patient are key factors in establishing the recovery time, which may be range from 8 weeks to 6 months. Back surgery can be performed to prevent the growth of benign and malignant tumors. In the first case, surgery has the goal of relieving the pressure from the nerves which is caused by a benign growth, whereas in the latter the procedure is aimed to prevent the spread of cancer to other areas of the body. Recovery depends on the type of tumor that is being removed, the health status of the patient and the size of the tumor. About 50% of women experience low back pain during pregnancy. Back pain in pregnancy may be severe enough to cause significant pain and disability and pre-dispose patients to back pain in a following pregnancy. No significant increased risk of back pain with pregnancy has been found with respect to maternal weight gain, exercise, work satisfaction, or pregnancy outcome factors such as birth weight, birth length, and Apgar scores. Biomechanical factors of pregnancy that are shown to be associated with low back pain of pregnancy include abdominal sagittal and transverse diameter and the depth of lumbar lordosis. Typical factors aggravating the back pain of pregnancy include standing, sitting, forward bending, lifting, and walking. Back pain in pregnancy may also be characterized by pain radiating into the thigh and buttocks, night-time pain severe enough to wake the patient, pain that is increased during the night-time, or pain that is increased during the day-time. The avoidance of high impact, weight-bearing activities and especially those that asymmetrically load the involved structures such as: extensive twisting with lifting, single-leg stance postures, stair climbing, and repetitive motions at or near the end-ranges of back or hip motion can ease the pain. Direct bending to the ground without bending the knee causes severe impact on the lower back in pregnancy and in normal individuals, which leads to strain, especially in the lumbo-saccral region that in turn strains the multifidus. Back pain is regularly cited by national governments as having a major impact on productivity, through loss of workers on sick leave. Some national governments, notably Australia and the United Kingdom, have launched campaigns of public health awareness to help combat the problem, for example the Health and Safety Executive's Better Backs campaign. In the United States lower back pain's economic impact reveals that it is the number one reason for individuals under the age of 45 to limit their activity, second highest complaint seen in physician's offices, fifth most common requirement for hospitalization, and the third leading cause for surgery. M: CNS anat (n/s/m/p/4/e/b/d/c/a/f/l/g)/phys/devp noco (m/d/e/h/v/s)/cong/tumr, sysi/epon, injr proc, drug (N1A/2AB/C/3/4/7A/B/C/D) M: PNS anat (h/r/t/c/b/l/s/a)/phys (r)/devp/prot/nttr/nttm/ntrp noco/auto/cong/tumr, sysi/epon, injr proc, drug (N1B) M: JNT anat (h/c, u, t, l)/phys noco (arth/defr/back/soft)/cong, sysi/epon, injr proc, drug (M01C, M4)
The limbs of the horse are structures made of dozens of bones, joints, muscles, tendons and ligaments that support the weight of the equine body. They include two apparatuses: the suspensory apparatus, which carries much of the weight, prevents overextension of the joint and absorbs shock, and the stay apparatus, which locks major joints in the limbs, allowing horses to remain standing while relaxed or asleep. The limbs play a major part in the movement of the horse, with the legs performing the functions of absorbing impact, bearing weight, and providing thrust. The hooves are also important structures, providing support, traction and shock absorption, and containing structures which provide blood flow through the lower leg. Good conformation in the limbs leads to improved movement and decreased likelihood of injuries. Large differences in bone structure and size can be found in horses used for different activities, but correct conformation remains relatively similar across the spectrum. Structural defects, as well as other problems such as injuries and infections, can cause lameness, or movement at an abnormal gait. Injuries to and problems with horse legs can be relatively minor, such as stocking up, which causes swelling without lameness, or quite serious. Even non-fatal leg injuries can be fatal to horses, as their bodies are designed to bear weight on all four legs and serious problems can result if this is not possible. Each forelimb of the horse runs from the scapula or shoulder blade to the navicular bone. In between are the humerus (arm), radius (forearm), ulna (elbow), carpal (knee), large metacarpal (cannon), small metacarpal (splint), sesamoid, first phalanx (long pastern), second phalanx (short pastern) and third phalanx (coffin or pedal) bones. Each hind limb of the horse runs from the pelvis to the navicular bone. After the pelvis come the femur (thigh), patella, tibia, fibula, tarsal (hock), large metatarsal (cannon) and small metatarsal (splint) bones. Below these, the arrangement of sesamoid and phalanx bones is the same as in the forelimbs. In the forelimbs there are also the elbow, knee, fetlock, pastern and coffin joints. The hind limbs contain the stifle and hock joints in the upper portion, and the same arrangement of fetlock, pastern and coffin joints as the lower forelimbs. When the horse is moving, the distal interphalangeal joint (coffin joint) has the highest amount of stresses applied to it of any joint in the body, and it can be significantly affected by trimming and shoeing techniques. Although having a small range of movement, the proximal interphalangeal joint (pastern joint) is also influential to the movement of the horse, and can change the way that various shoeing techniques affect tendons and ligaments in the legs. There are three main muscle groups of the forelimb. The triceps muscle straightens the elbow and foreleg, running from the elbow to the bottom of the shoulder blade. The muscles which extend the lower leg are called extensor muscles, while the flexion of the lower leg joints is achieved through movement of the flexor muscles. There are five main muscles and muscle groups in the hind legs. The vastus muscle flexes the hind leg and runs from stifle to hip, while the gluteal muscles, the large muscles in the hip, extend the femur. Forward motion and flexion of the hind legs is achieved through the movement of the quadriceps group of muscles on the front of the femur, while the muscles at the back of the hindquarters, called the hamstring group, provide forward motion of the body and rearward extension of the hind limbs. Extension of the hock is achieved by the Achilles tendon, located above the hock. There are two apparatus in the limbs of the horse - the suspensory apparatus and the stay apparatus. The fetlock joint is supported by group of lower leg ligaments, tendons and bones known as the suspensory apparatus. This apparatus carries much of the weight, prevents overextension of the joint and absorbs shock. It also helps provide a rebound effect, which assists the foot in leaving the ground. The suspensory apparatus consists of the suspensory ligament, the check ligament, the deep digital flexor tendon, the superficial flexor tendon, the common digital extensor tendon and the sesamoid bones. Horses use a group of ligaments, tendons and muscles known as the stay apparatus to lock major joints in the limbs, allowing them to remain standing while relaxed or asleep. The lower part of the stay apparatus consists of the suspensory apparatus, which is the same in both sets of limbs, while the upper portion differs between the fore and hind limbs. The upper portion of the stay apparatus in the forelimbs includes the major attachment, extensor and flexor muscles and tendons. The same portion in the hind limbs consists of the major muscles, ligaments and tendons, as well as the reciprocal joints of the hock and stifle. Horses are odd-toed ungulates, or members of the order Perissodactyla. This order also includes the extant species of rhinos and tapirs, and many extinct families and species. Members of this order walk on either one toe (like horses) or three toes (like rhinos and tapirs). This is in contrast to even-toed ungulates, members of the order Artiodactyla, which walk on cloven hooves, or two toes. This order includes many species associated with livestock, such as sheep, goats, pigs, cows and camels, as well as species of giraffes, antelopes and deer. The hoof of the horse contains over a dozen different structures, including bones, cartilage, tendons and tissues. The coffin or pedal bone is the major hoof bone, supporting the majority of the weight. Under the coffin bone is the navicular bone, itself cushioned by the navicular bursa, a fluid-filled sac. The digital cushion is a blood vessel-filled structure located in the middle of the hoof, which assists with blood flow throughout the leg. At the top of the hoof wall is the corium, tissue which continually produces the horn of the outer hoof shell, which is in turn protected by the periople, a thin outer layer which prevents the interior structures from drying out. The wall is connected to the coffin bone by sensitive laminae, a flexible layer which helps to suspend and protect the coffin bone. The main tendon in the hoof is the deep digital flexor tendon, which connects to the bottom of the coffin bone. The impact zone on the bottom of the hoof includes the sole, which has an outer, insensitive layer and a sensitive inner layer, and the frog, which lies between the heels and assists in shock absorption and blood flow. The final structures are the lateral cartilages, connected to the upper coffin bone, which act as the flexible heels, allowing hoof expansion. These structures allow the hoof to perform many functions. It acts as a support and traction point, shock absorber and system for pumping blood back through the lower limb. A sequence of movements in which a horse takes a step with all four legs is called a stride. During each step, with each leg, a horse completes four movements: the swing phase, the grounding or impact, the support period and the thrust. While the horse uses muscles throughout its body to move, the legs perform the functions of absorbing impact, bearing weight, and providing thrust. Good movement is sound, symmetrical, straight, free and coordinated, all of which depend on many factors, including conformation, soundness, care and training of the horse, and terrain and footing. The proportions and length of the bones and muscles in the legs can significantly impact the way an individual horse moves. The angles of certain bones, especially in the hind leg, shoulders, and pasterns, also affect movement. The forelegs carry the majority of the weight, with exact percentages depending on speed and gait. At one point in the gallop, all weight is resting on one front hoof. "Form to function" is a term used in the equestrian world to mean that the "correct" form or structure of a horse is determined by the function for which it will be used. The legs of a horse used for cutting, in which quick starts, stops and turns are required, will be shorter and more thickly built than those of a Thoroughbred racehorse, where forward speed is most important. However, despite the differences in bone structure needed for various uses, correct conformation of the leg remains relatively similar. The ideal horse has legs which are straight, correctly set and symmetrical. Correct angles of major bones, clean, well-developed joints and tendons, and well-shaped, properly-proportioned hooves are also necessary for ideal conformation. "No legs, no horse" and "no hoof, no horse" are common sayings in the equine world. Individual horses may have structural defects, some of which lead to poor movement or lameness. Although certain defects and blemishes may not directly cause lameness, they can often put stress on other parts of the body, which can then cause lameness or injuries. Poor conformation and structural defects do not always cause lameness, however, as was shown by the champion racehorse Seabiscuit, who was considered undersized and knobby-kneed for a Thoroughbred. Common defects of the forelegs include base-wide and base-narrow, where the legs are farther apart or closer together on the ground then they are when the originate in the chest; toeing-in and toeing-out, where the hooves point inwards or outwards; knee deviations to the front (buck knees), rear (calf knees), inside (knock knees) or outside (bowleg); short or long pasterns; and many problems with the feet. Common defects of the hind limbs include the same base-wide and base-narrow stances and problems with the feet as the fore limbs, as well as multiple issues with the angle formed by the hock joint being too angled (sickle-hocked), too straight (straight behind) or having an inward deviation (cow-hocked). Feral horses are seldom found with serious conformation problems in the leg, as foals with these defects are generally easy prey for predators. Foals raised by humans have a better chance for survival, as there are therapeutic treatments that can improve even major conformation problems. However, some of these conformation problems can be transmitted to offspring, and so these horses are a poor choice for breeding stock. Lameness in horses is movement at an abnormal gait due to pain in any part of the body. It is frequently caused by pain to the shoulders, hips, legs or feet. Lameness can also be caused by abnormalities in the digestive, circulatory and nervous systems. While horses with poor conformation and congenital conditions are more likely to develop lameness, trauma, infection and acquired abnormalities are also causes. The largest cause of poor performance in equine athletes is lameness caused by abnormalities in the muscular or skeletal systems. The majority of lameness is found in the forelimbs, with at least 95 percent of these cases stemming from problems in the structures from the knee down. Lameness in the hind limbs is caused by problems in the hock and/or stifle 80 percent of the time. There are numerous issues that can occur with horses' legs that may not necessarily cause lameness. Stocking up is an issue that occurs in horses that are held in stalls for multiple days after periods of activity. Fluid collects in the lower legs, producing swelling and often stiffness. Although it does not usually cause lameness or other problems, prolonged periods of stocking up can lead to other skin issues. Older horses and horse with heavy muscling are more prone to this condition. A shoe boil is an injury that occurs when there is trauma to the bursal sac of the elbow, causing inflammation and swelling. Multiple occurrences can cause a cosmetic sore and scar tissue, called a capped elbow, or infections. Shoe boils generally occur when a horse hits its elbow with a hoof or shoe when lying down. Windpuffs, or swelling to the back of the fetlock caused by inflammation of the sheaths of the deep digital flexor tendon, appear most often in the rear legs. Soft and fluid-filled, the swelling may initially be accompanied by heat and pain, but can remain long after the initial injury has healed without accompanying lameness. Repeated injuries to the tendon sheath, often caused by excessive training or work on hard surfaces, can cause larger problems and lameness. Leg injuries that are not immediately fatal still may be life-threatening because a horse's weight must be distributed evenly on all four legs to prevent circulatory problems, laminitis, and other infections. If a horse loses the use of one leg temporarily, there is the risk that other legs will break down during the recovery period because they are carrying an abnormal weight load. While horses periodically lie down for brief periods of time, a horse cannot remain lying in the equivalent of a human's "bed rest" because of the risk of developing sores, internal damage, and congestion.
Referred pain, also called reflective pain, is pain perceived at a location other than the site of the painful stimulus. An example is the case of ischemia brought on by a myocardial infarction (heart attack), where pain is often felt in the neck, shoulders, and back rather than in the chest, the site of the injury. The International Association for the Study of Pain, as of 2001, has not officially defined the term; hence several authors have defined the term differently. Radiation is different from referred pain. The pain related to a myocardial infarction could either be referred pain or pain radiating from the chest. Classically the pain associated with a myocardial infarction is located in the mid or left side of the chest where the heart is actually located. The pain can radiate to the left side of the jaw and into the left arm. Referred pain is when the pain is located away from or adjacent to the organ involved. Referred pain would be when a person has pain only in their jaw or left arm, but not in the chest. Myocardial infarction can rarely present as referred pain and this usually occurs in people with diabetes or older age. Physicians and scientists have known about referred pain since the late 1880s. Despite an increasing amount of literature on the subject, the mechanism of referred pain is unknown, although there are several hypotheses. There are several proposed mechanisms for referred pain. Currently there is no definitive consensus regarding which is correct. The cardiac general visceral sensory pain fibers follow the sympathetics back to the spinal cord and have their cell bodies located in thoracic dorsal root ganglia 1-4(5). As a general rule, in the thorax and abdomen, general visceral afferent (GVA) pain fibers follow sympathetic fibers back to the same spinal cord segments that gave rise to the preganglionic sympathetic fibers. The central nervous system (CNS) perceives pain from the heart as coming from the somatic portion of the body supplied by the thoracic spinal cord segments 1-4(5). Also, the dermatomes of this region of the body wall and upper limb have their neuronal cell bodies in the same dorsal root ganglia (T1-5) and synapse in the same second order neurons in the spinal cord segments (T1-5) as the general visceral sensory fibers from the heart. The CNS does not clearly discern whether the pain is coming from the body wall or from the viscera, but it perceives the pain as coming from somewhere on the body wall, i.e. substernal pain, left arm/hand pain, jaw pain. This represents one of the earliest theories on the subject of referred pain. It is based on the work of W.A. Sturge and J. Ross from 1888 and later TC Ruch in 1961. Convergent projection proposes that afferent nerve fibers from tissues converge onto the same spinal neuron, and explains why referred pain is believed to be segmented in much the same way as the spinal cord. Additionally, experimental evidence shows that when local pain (pain at the site of stimulation) is intensified the referred pain is intensified as well. Criticism of this model arises from its inability to explain why there is a delay between the onset of referred pain after local pain stimulation. Experimental evidence also shows that referred pain is often unidirectional. For example stimulated local pain in the anterior tibial muscle causes referred pain in the ventral portion of the ankle; however referred pain moving in the opposite direction has not been shown experimentally. Lastly, the threshold for the local pain stimulation and the referred pain stimulation are different, but according to this model they should both be the same. Convergence facilitation was conceived in 1893 by J MacKenzie based on the ideas of Sturge and Ross. He believed that the internal organs were insensitive to stimuli. Furthermore, he believed that nonnociceptive afferent inputs to the spinal cord created what he termed "an irritable focus". This focus caused some stimuli to be perceived as referred pain. However, his ideas did not gain widespread acceptance from critics due to its dismissal of visceral pain. Recently this idea has regained some credibility under a new term, central sensitization. In this form, it explains why changes in somatosensory sensibility could be undergoing processes similar to the dorsal horn and the brainstem. Additionally, the delay in appearance of referred pain shown in laboratory experiments can be explained due to the time required to create the central sensitization. Axon reflex suggests that the afferent fiber is bifurcated before connecting to the dorsal horn. Bifurcated fibers do exist in muscle, skin, and intervertebral discs. Yet these particular neurons are rare and are not representative of the whole body. Axon-Reflex also does not explain the time delay before the appearance of referred pain, threshold differences for stimulating local and referred pain, and somatosensory sensibility changes in the area of referred pain. Hyperexcitability hypothesizes that referred pain has no central mechanism. However, it does say that there is one central characteristic that predominates. Experiments involving noxious stimuli and recordings from the dorsal horn of animals revealed that referred pain sensations began minutes after muscle stimulation. Pain was felt in a receptive field that was some distance away from the original receptive field. According to hyperexcitability, new receptive fields are created as a result of the opening of latent convergent afferent fibers in the dorsal horn. This signal could then be perceived as referred pain. Several characteristics are in line with this mechanism of referred pain, such as dependency on stimulus and the time delay in the appearance of referred pain as compared to local pain. However, the appearance of new receptive fields, which is interpreted to be referred pain, conflicts with the majority of experimental evidence from studies including studies of healthy individuals. Furthermore, referred pain generally appears within seconds in humans as opposed to minutes in animal models. Some scientists attribute this to a mechanism or influence downstream in the supraspinal pathways. Neuroimaging techniques such as PET scans or fMRI may visualize the underlying neural processing pathways responsible in future testing. Thalamic convergence suggests that referred pain is perceived as such due to the summation of neural inputs in the brain, as opposed to the spinal cord, from the injured area and the referred area. Experimental evidence on thalamic convergence is lacking. However, pain studies performed on monkeys revealed several pathways converging on both subcortical and cortical neurons. Pain is studied in a laboratory setting due to the greater amount of control that can be exerted. For example the modality, intensity, and timing of painful stimuli can be controlled with much more precision. Within this setting there are two main ways that referred pain is studied. In recent years several different chemicals have been used to induce referred pain including bradykinin, substance P, capsaicin, and serotonin. However before any of these substances became widespread in their use a solution of hypertonic saline was used instead. Through various experiments it was determined that there were multiple factors that correlated with saline administration such as infusion rate, saline concentration, pressure, and amount of saline used. The mechanism by which the saline induces a local and referred pain pair is unknown. Some researchers have commented that it could be due to osmotic differences, however that is not verified. Intramuscular electrical stimulation (IMES) of muscle tissue has been used in various experimental and clinical settings. The advantage to using an IMES system over a standard such as hypertonic saline is that IMES can be turned on and off. This allows the researcher to exert a much higher degree of control and precision in terms of the stimulus and the measurement of the response. The method is easier to carry out than the injection method as it does not require special training in how it should be used. The frequency of the electrical pulse can also be controlled. For most studies a frequency of about 10 Hz is needed to stimulate both local and referred pain. Using this method it has been observed that significantly higher stimulus strength is needed to obtain referred pain relative to the local pain. There is also a strong correlation between the stimulus intensity and the intensity of referred and local pain. It is also believed that this method causes a larger recruitment of nociceptor units resulting in a spatial summation. This spatial summation results in a much larger barrage of signals to the dorsal horn and brainstem neurons. Referred pain can be indicative of nerve damage. A case study done on a 63 year old man with a sustained injury during his childhood developed referred pain symptoms after his face or back was touched. After even a light touch, there was shooting pain in his arm. The study concluded that the reason for this man's pain was possibly due to a neural reorganization which sensitized regions of his face and back after the nerve damage occurred. It is mentioned that this case is very similar to what phantom limb syndrome patients suffer. This conclusion was based on experimental evidence gathered by V. Ramachandran in 1993, with the difference being that the arm that is in pain is still attached to the body.][ From the above examples one can see why understanding of referred pain can lead to better diagnoses of various conditions and diseases. In 1981 physiotherapist Robin McKenzie described what he termed centralization. He concluded that centralization occurs when referred pain moves from a distal to a more proximal location. Observations in support of this idea were seen when patients would bend backward and forward during an examination. Studies have reported that the majority of patients that centralized were able to avoid spinal surgery via isolating the area of local pain. However, the patients that did not centralize had to undergo surgery to diagnose and correct problems. As a result of this study there has been a lot of research into the elimination of referred pain through certain body movements. One example of this is referred pain in the calf. McKenzie showed that the referred pain would move closer to the spine when the patient bent backwards in full extension a few times. More importantly, the referred pain would dissipate even after the movements were stopped. As with myocardial ischaemia referred pain in a certain portion of the body can lead to a diagnosis of the correct local center. Somatic mapping of referred pain and the corresponding local centers has led to various topographic maps being produced to aid in pinpointing the location of pain based on the referred areas. For example local pain stimulated in the esophagus is capable of producing referred pain in the upper abdomen, the oblique muscles, and the throat. Local pain in the prostate can radiate referred pain to the abdomen, lower back, and calf muscles. Kidney stones can cause visceral pain in the ureter as the stone is slowly passed into the excretory system. This can cause immense referred pain in the lower abdominal wall. Further, recent research has found that ketamine, a sedative, is capable of blocking referred pain. The study was conducted on patients suffering from fibromyalgia, a disease characterized by joint and muscle pain and fatigue. These patients were looked at specifically due to their increased sensitivity to nociceptive stimuli. Furthermore, referred pain appears in a different pattern in fibromyalgic patients than non-fibromyalgic patients. Often this difference manifests as a difference in terms of the area that the referred pain is found (distal vs. proximal) as compared to the local pain. The area is also much more exaggerated owing to the increased sensitivity. M: CNS anat (n/s/m/p/4/e/b/d/c/a/f/l/g)/phys/devp noco (m/d/e/h/v/s)/cong/tumr, sysi/epon, injr proc, drug (N1A/2AB/C/3/4/7A/B/C/D) M: PNS anat (h/r/t/c/b/l/s/a)/phys (r)/devp/prot/nttr/nttm/ntrp noco/auto/cong/tumr, sysi/epon, injr proc, drug (N1B)
ankle Swelling pain Health Sprain Pain Ankle

Tarsal tunnel syndrome (TTS), also known as posterior tibial neuralgia, is a compression neuropathy and painful foot condition in which the tibial nerve is compressed as it travels through the tarsal tunnel. This tunnel is found along the inner leg behind the medial malleolus (bump on the inside of the ankle). The posterior tibial artery, tibial nerve, and tendons of the tibialis posterior, flexor digitorum longus, and flexor hallucis longus muscles travel in a bundle through the tarsal tunnel. Inside the tunnel, the nerve splits into three different segments. One nerve (calcaneal) continues to the heel, the other two (medial and lateral plantar nerves) continue on to the bottom of the foot. The tarsal tunnel is delineated by bone on the inside and the flexor retinaculum on the outside.

Patients with TTS typically complain of numbness in the foot radiating to the big toe and the first 3 toes, pain, burning, electrical sensations, and tingling over the base of the foot and the heel. Depending on the area of entrapment, other areas can be affected. If the entrapment is high, the entire foot can be affected as varying branches of the tibial nerve can become involved. Ankle pain is also present in patients who have high level entrapments. Inflammation or swelling can occur within this tunnel for a number of reasons. The flexor retinaculum has a limited ability to stretch, so increased pressure will eventually cause compression on the nerve within the tunnel. As pressure increases on the nerves, the blood flow decreases. Nerves respond with altered sensations like tingling and numbness. Fluid collects in the foot when standing and walking and this makes the condition worse. As small muscles lose their nerve supply they can create a cramping feeling.

Lameness Anatomy Medicine

A sprained ankle, also known as an ankle sprain, twisted ankle, rolled ankle, floppy ankle, ankle injury or ankle ligament injury, is a common medical condition where one or more of the ligaments of the ankle is torn or partially torn.

Knowing the symptoms that can be experienced with a sprain is important in determining that the injury is not really a break in the bone. When a sprain occurs, blood vessels will leak fluid into the tissue that surrounds the joint. White blood cells responsible for inflammation migrate to the area, and blood flow increases as well. Along with this inflammation, swelling from the fluid and pain is experienced. The nerves in the area become more sensitive when the injury is suffered, so pain is felt as throbbing and will worsen if there is pressure placed on the area. Warmth and redness are also seen as blood flow is increased. Also present is a decreased ability to move the joint, and difficulty using the affected leg.

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