Trainee Advanced Clinical Practitioner Diary- Day 9 - Critical Care Practitioner

Trainee Advanced Clinical Practitioner Diary- Day 9

Tenosynovitis, Ottawa ankle rule, Weber classification of fracture


Inflammation of the sheath that covers the tendon. The sheath is called the synovium and it secretes fluid which allows the tendon to move freely.

Can also be called tendinosis or tendinopathy.

  • De Quervain’s tenosynovitis. This is a common condition that affects the tendons that are used to straighten (extend) your thumb. The typical symptom is pain over your wrist at the base of your thumb that is made worse by activity and eased by rest.
  • Trigger finger. This most commonly affects your ring finger. The condition prevents your finger from straightening fully.
  • Tennis elbow (lateral epicondylitis). In this condition, you have pain on the outer side of your elbow. It is usually due to overuse of your forearm muscles.
  • Golfer’s elbow (medial epicondylitis). This is similar to tennis elbow but the pain is experienced on the inner side of your elbow.
  • Achilles tendonitis. This affects the large tendon just behind and above the heel
  • Rotator cuff tendonitis. Your rotator cuff is a group of four muscles that help to lift and rotate your shoulder. The tendons from these muscles can sometimes become irritated due to overuse.

Hawkes Physiotherapy Tenosynovitis of the Wrist Extensors Video

Ottawa ankle rule.

If there is a history of indirect injury and the patient is between the ages of 9-65 then X ray the ankle or foot if:

  • Patient cannot take 4 steps.
  • Tender medial malleolus
  • Tender lateral malleolus
  • Tender at the base of the 5th metatarsal
  • Tender navicular.

Ottawa rules for X ray of knee, ankle and foot.

MedCalc Ottawa ankle rules

Ottawa ankle and foot.


Weber Fracture.

Classification of fracture of lateral malleolus.

  • Type A
    • Below level of ankle joint
    • tibiofibular syndesmosis intact
    • deltoid ligament intact
    • medial malleolus often fractured
    • usually stable
Weber A
Weber A



  • Type B
    • at the level of the ankle joint, extending superiorly and laterally up the fibula.
    • tibiofibular syndesmosis intact or only partially torn, but no widening of the distal tibiofibular articulation.
    • medial malleolus may be fractured or deltoid ligament may be torn.
    • variable stability
Weber B
Weber B



  • Type C
    • above the ankle joint.
    • tibiofibular syndesmosis disrupted with widening of the distal tibiofibular articulation.
    • medial malleolus fracture or deltoid ligament injury present.
Weber C
Weber C


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