00:04 - 00:07This is run of the Brooke Bush Institute in this video. We're gonna go over
00:07 - 00:10two special tests for ankle joint stability. We're going
00:10 - 00:13to go over the anterior drawer test which tests Integrity
00:13 - 00:16of the anterior Taylor fibular ligament also
00:16 - 00:19known as the atfl then we're all going to do
00:19 - 00:22the calcaneal tilt test also known
00:22 - 00:25as The sub-taylor Joint stability test. I'm going to
00:25 - 00:28have my friend a vet come out. She's gonna help me demonstrate. Now. These
00:28 - 00:31are two tests we tend to use after acute ankle injury,
00:31 - 00:34right? We're gonna test the Integrity of
00:34 - 00:37these ligaments around the ankle to make sure that we have enough
00:37 - 00:41stability to go ahead and start our intervention. Now
00:40 - 00:43I'm going to have event go
00:43 - 00:46ahead and move this leg. This isn't actually part of the test. I just want you guys to be able to
00:46 - 00:50see her ankle the anterior Taylor fibula ligament helps prevent
00:49 - 00:52the tailless from moving posterior to
00:52 - 00:52anterior.
00:53 - 00:56So just like the ACL prevents the tibia from
00:56 - 00:59moving post here to anterior. We need to create a posterior
00:59 - 01:02to anterior Force to see if we still have
01:02 - 01:05integrity in that ligament. The way we're going
01:05 - 01:08to do that is I'm going to brace or tibia and then I'm going
01:08 - 01:11to wrap my hand around her calcaneus. Remember how tightly bound your
01:11 - 01:12tailles and calcaneus are.
01:13 - 01:16I'm gonna go ahead and wrap my forearm around the bottom of her foot
01:16 - 01:19just so I have a little control over plantar flexion and dorsiflexion, but
01:19 - 01:22I don't want to push her into dorsiflexion. I don't want to
01:22 - 01:26push her into plantar flex and I want to keep her pretty neutral. So
01:25 - 01:28no other ligaments can pick up
01:28 - 01:30the slack for this thing that we're trying to test.
01:31 - 01:34Once I get into position, all I'm going to do is pull straight up.
01:34 - 01:37And I'm gonna kind of take mental note of how much
01:37 - 01:38movement.
01:39 - 01:42Did I get out of her tailus? I should
01:42 - 01:45only get a few millimeters. Alright, so I'm gonna
01:45 - 01:48check that out. And if I wasn't sure like I didn't have a
01:48 - 01:51good internal frame of reference. I guess. I haven't felt enough ankles. I
01:51 - 01:54could compare her affected ankle.
01:55 - 01:58To her other side so I'm gonna
01:58 - 02:01have a vet bring this up and I'm just gonna go ahead and compare excuse my back
02:01 - 02:03brace or her tibia.
02:03 - 02:04Get my hand wrapped around.
02:05 - 02:09Pull up see how much motions there. Once again.
02:08 - 02:11I'm getting millimeters not centimeters.
02:13 - 02:16Alright and they feel pretty even to me. Now. The
02:16 - 02:19other thing I might want to check for is did any of those cause pain?
02:20 - 02:24No, we it is possible that we still have an
02:23 - 02:24atfl.
02:25 - 02:28But that the atfl was damaged and if that is
02:28 - 02:31causing some of her symptoms, it might be something we want to keep track of.
02:32 - 02:35Right, but this is this is not quite the same as a concordant sign,
02:35 - 02:38right if we have an atfl strain. It's not
02:38 - 02:41going to necessarily feel better right after we've done
02:41 - 02:44some physical therapy. It's going to take a few weeks for everything to
02:44 - 02:47scar down and heal. Now. The other test we're going to try is
02:47 - 02:50the sub-taylor joint stability test also known
02:50 - 02:53as the calcaneal tilt test. Remember the Taylors and
02:53 - 02:56the calcaneus kind of stack on top of each other
02:56 - 02:59and there are joints in there. Although they are very bound down
02:59 - 03:02by ligament. So if we get a lot of movement in there, there's a
03:02 - 03:05good chance. We we have some damage and some instability. So
03:05 - 03:08again, I'm having move this Lake here. Now, what we're
03:08 - 03:11gonna do is we're gonna brace the tailless, right? So
03:11 - 03:14I'm gonna go ahead and just slide my fingers over Tails,
03:14 - 03:18like right underneath her mouth there. Right? Most
03:17 - 03:20of what I'm gonna do is brace or
03:20 - 03:21Taylor Swift with this part of my hand.
03:22 - 03:26I'm then going to take the palm of my other hand and push
03:25 - 03:28her calcaneus medially. So
03:28 - 03:30I got my tailless blocked this way.
03:32 - 03:33The calcaneus I'm moving medially.
03:36 - 03:36No pain.
03:37 - 03:40I'm paying and it doesn't move much and of course if I
03:40 - 03:43thought it was moving way too much. What could I do?
03:44 - 03:45I could test it against the other side.
03:46 - 03:49Right we could again if it was causing her pain keep
03:49 - 03:52track of that again. This isn't like a concordant
03:52 - 03:55sign test though, one of those pain provocation tests
03:55 - 03:58where we're gonna see a huge change if she
03:58 - 04:01damaged ligaments, it's gonna take some weeks to scar down. I will
04:01 - 04:04show you guys one one. Let me have you move this
04:04 - 04:07down. So you guys one shortcut on the
04:07 - 04:10anterior drawer test, I would start with exactly the way I
04:10 - 04:13showed you just to get used to this but a quick
04:13 - 04:14test you can do
04:15 - 04:19we can reverse the mechanics of our atfl test
04:18 - 04:21and instead of pulling the
04:21 - 04:24Taylors posterior to anterior. I could
04:24 - 04:27brace her foot and see
04:27 - 04:29if her tibia moves on our tailis.
04:30 - 04:34But then of course, I have to remember that that's tibia anterior
04:33 - 04:36to posterior right? Because
04:36 - 04:39that would be the same as posterior to anterior Taylor. You guys got that.
04:42 - 04:42so
04:43 - 04:46Why would I use these tests? This is an important
04:46 - 04:49question. Right? So these are moral on
04:49 - 04:52the lines of tests that we would use to clear a patient for physical therapy.
04:53 - 04:56If she has massive amounts of
04:56 - 04:59instability, like I get a positive anterior drawer
04:59 - 05:02or a really positive sub-taylor stability
05:02 - 05:02test.
05:03 - 05:06I need to keep in the back of my mind that we might
05:06 - 05:09start down the road of physical therapy and if she's
05:09 - 05:09not getting better.
05:11 - 05:12I might want to refer out.
05:13 - 05:16I mean if it's if it's a lot of instability and she feels
05:16 - 05:19a couple more of our ankle joint stability tests.
05:19 - 05:22I might want to refer out because there
05:22 - 05:26is a line that can be crossed where without surgical intervention it's
05:25 - 05:29very unlikely that somebody is going to get better.
05:30 - 05:33So that's where these tests fall in stay tuned for
05:33 - 05:37our close-up recap. Alright guys. Just wanted to show you a quick recap
05:36 - 05:39close-up for the anterior drawer
05:39 - 05:42and the sub-taylor joint instability test
05:42 - 05:45because I know the hand positions can get a little tricky for the
05:45 - 05:48anterior drawer test. I'm just gonna wrap my hand around
05:48 - 05:51the bottom of our calcaneus throw my Forum underneath the
05:51 - 05:54bottom of her foot so I can control dorsiflexion and
05:54 - 05:58plantar flexion. Now, of course, I want to find that neutral position where I have not much
05:57 - 06:00passive resistance. I'm going to
06:00 - 06:03use my other hand to stabilize or tibia, and then I'm going to
06:03 - 06:05create a posterior to anterior Force.
06:06 - 06:09If I notice more than a few millimeters of motion.
06:10 - 06:11Of course. I know I have a problem.
06:12 - 06:14I may be lacking some integrity.
06:15 - 06:18in that anterior talofibular ligament the
06:18 - 06:19atfl
06:19 - 06:22Of course, I could compare it to the other side because just
06:22 - 06:25kind of notice my hand position here stabilizing the
06:25 - 06:29tibia hand around the calcaneus controlling planter
06:28 - 06:31and dorsiflexion with my forearm. Now that
06:31 - 06:33sub-taylor joint instability test.
06:34 - 06:37I'm gonna let my hand slide right over
06:37 - 06:40the taylis. All right, so I'm using this part
06:40 - 06:43of my hand here around the neck of
06:43 - 06:46the Talis by sliding my thumb and index
06:46 - 06:48finger right underneath the malleoli.
06:49 - 06:52Once I do that, I know her Talus is
06:52 - 06:54pretty well stabilized the special if I block.
06:55 - 06:55With this part of the hand.
06:56 - 06:59I'm gonna grab a bunch of calcaneus with my other hand
06:59 - 07:01take up inversion.
07:02 - 07:03At least as much as I need to.
07:04 - 07:07To get a good block on that Taylor's and
07:07 - 07:10then I'm gonna just kind of give a couple thrusts almost
07:10 - 07:13like a mobilizing her calcaneus and because that
07:13 - 07:16tailless and calcaneus are so tightly bound. I
07:16 - 07:19know that if I get anything more than a small
07:19 - 07:20amount of motion.
07:21 - 07:24I might have a problem. There might be a little bit of ligament damage
07:24 - 07:24in there.
07:25 - 07:28So there you guys have it. Those are two hand positions practice
07:28 - 07:31them a little bit before you see a patient. If you have any
07:31 - 07:32questions leave them in the comments box below.