Ankle sprain: Difference between revisions
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**No tearing of ligaments | **No tearing of ligaments | ||
**Minimal pain, swelling, ecchymosis; weightbearing is tolerable | **Minimal pain, swelling, ecchymosis; weightbearing is tolerable | ||
**No splinting/casting; weight bearing as tolerated, isometric exercises, full ROM and stretching/strengthening exercises | |||
*Grade II | *Grade II | ||
**Partial ligament tear | **Partial ligament tear | ||
**Increased pain, swelling, ecchymosis; difficulty bearing weight | **Increased pain, swelling, ecchymosis; difficulty bearing weight | ||
**Immoblize with air splint; PT with ROM/stretching/strengthening exercises | |||
*Grade III | *Grade III | ||
**Complete ligament tear | **Complete ligament tear | ||
**Severe pain, swelling, ecchymosis; inability to bear weight | **Severe pain, swelling, ecchymosis; inability to bear weight | ||
**Immobilization and possible surgery; PT same as grade 2 but longer time period | |||
===Management=== | ===Management=== | ||
Revision as of 22:33, 25 August 2014
Background
- Ankle stabilization:
- Syndesmosis
- Ligaments
- Medial: Medial collateral (deltoid) ligament (tibia to talus and calcaneus)
- Lateral: Anterior/posterior talofibular, calcaneofibular ligaments
Clinical Features
- Lateral Ankle Sprain
- Most common
- Due to inversion of plantarflexed ankle
- Anterior talofibular ligament (ATFL) is most commonly injured ligament
- Medial Ankle Sprain
- Isolated sprain is unusual; often associated w/ fibular fx or syndesmosis injury
- Always rule-out Maisonneuve fx by evaluating proximal fibula
- Syndesmotic Sprain ("High-ankle sprain")
- Assoc w/ hyperdorsiflexion when talus moves superiorly and separates tibia/fibula
- Pain just above talus
Diagnosis
- Anterior drawer test
- Tests anterior talofibular ligament
- Cup heel w/ one hand and and pull anteriorly while pushing tibia posteriorly
- Talar tilt test
- Tests for combined injury of anterior talofibular and calcaneofibular ligaments
- Inversion at the ankle causes tilting/lifting of the mortise joint
Classification
- Grade I
- No tearing of ligaments
- Minimal pain, swelling, ecchymosis; weightbearing is tolerable
- No splinting/casting; weight bearing as tolerated, isometric exercises, full ROM and stretching/strengthening exercises
- Grade II
- Partial ligament tear
- Increased pain, swelling, ecchymosis; difficulty bearing weight
- Immoblize with air splint; PT with ROM/stretching/strengthening exercises
- Grade III
- Complete ligament tear
- Severe pain, swelling, ecchymosis; inability to bear weight
- Immobilization and possible surgery; PT same as grade 2 but longer time period
Management
- Stable joint and ability to bear weight:
- NSAIDs, RICE (rest, ice, compression, elevation)
- 1 week f/u if no improvement
- Stable joint but unable to bear weight:
- Ankle brace w/ f/u in 1wk
- Unstable joint
- Posterior mold splint and ortho consult/referral
See Also
Source
- Tintinalli