View source for Ankle sprain

==Background==
stress tests-best done several days after injury.

anterior drawer- tests the anterior talar fibular ligament (ATFL). knee at 90 degrees, foot in relaxed position. cup heel with one hand and push on tibia posteriorly-positive is 2mm of subluxation relative to the other foot or visible dimpling of the anterior skin.

Talar tilt- tests ATFL and calcaneofibular ligament (CFL)-in same position as above-forced inversion of foot is applied- positive if there is obvious joint laxity relative to the other side or no passive resistance to forced motion-indicates rupture of ATFL and CFL. can do with forced eversion which tests the stability of the deltiod ligament.

Fibular compression: tests the tiobiofibular syndesmotic ligament. Same position as before but dorsiflex foot. squeeze tibia and fibula together 6-8 inches below knee. Positive tests if there is pain in the ankle.

Thompson's tests- prone with knee flexed squeeze gastroc and soleus in midcalf. if no plantarflexion-torn achilles tendon.

==Classification==
#Class I
## mild pain,swelling can bear weight, negative stress test-
##Treatment = RICE and f/u in 7 days.
#Class II
##mod pain, swelling, difficulty bearing weight, pos ant drawer (4-14 mm), pos talar tilt (5-15 degrees)
##Treatment: rigid splint, crutches, <7 day f/u.
#Class III
##severe pain, unable to bear weight, lot of swelling. ant drawer >15 mm, talar tilt >15 degrees
##Treatment: rigid splint, crutches, f/u in <7 days.

ATFL most common ligament (80% of inversion injuries).

eversion injuries- deltoid ligament rarely isolated tear-usually avulsion Fx of medial malleolus. syndesmotic sprains more common than deltoid injuries (and more easily missed).

grade 2 and 3 eversion injuries are often placed in a short leg walking cast for 6-8 weeks.

==Causes of Chronic Pain after Healing==
#soft tissue problems
##synovial impingement syndromes
##loose bodies in the joint
##proneal tendon subluxation
#bony problems
##osteochondral Fx of talar dome
##lateral or posterior fx of talus
##anterior fx of calcaneus

==Syndesmotic Sprain==
(High Ankle)

===Diagnosis===
#Positive squeeze test
#TTP distal tibiofibular joint

===Treatment===
#Treat as sprain, f/u ortho/sports
#possible surgical repair if refractory to conservative management 

[[Category:Ortho]]