Ankle sprain: Difference between revisions

Revision as of 22:14, 16 February 2012

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 of 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
Grade II
- Partial ligament tear
- Increased pain, swelling, ecchymosis; difficulty bearing weight
Grade III
- Complete ligament tear
- Severe pain, swelling, ecchymosis; inability to bear weight

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

Source

Tintinalli

Authors:

@@ Line 1: / Line 1: @@
 ==Background==
 *Ankle stabilization:
-**Medial: Medial collateral (deltoid) ligament (tibia to talus and calcaneus)
+**Syndesmosis
-**Lateral: Anterior/posterior talofibular, calcaneofibular ligaments
+**Ligaments
-***Weaker than medial ligament; more commonly injured in sprains
+***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 of proximal fibula
+*Syndesmotic Sprain ("High-ankle sprain")
+**Assoc w/ hyperdorsiflexion when talus moves superiorly and separates tibia/fibula
+**Pain just above talus
 ==Diagnosis==
@@ Line 14: / Line 27: @@
 ==Classification==
-#Class I
+*Grade I
-##mild pain,swelling can bear weight, negative stress test-
+**No tearing of ligaments
-##Treatment = RICE and f/u in 7 days.
+**Minimal pain, swelling, ecchymosis; weightbearing is tolerable
-#Class II
+*Grade II
-##mod pain, swelling, difficulty bearing weight, pos ant drawer (4-14 mm), pos talar tilt (5-15 degrees)
+**Partial ligament tear
-##Treatment: rigid splint, crutches, <7 day f/u.
+**Increased pain, swelling, ecchymosis; difficulty bearing weight
-#Class III
+*Grade III
-##severe pain, unable to bear weight, lot of swelling. ant drawer >15 mm, talar tilt >15 degrees
+**Complete ligament tear
-##Treatment: rigid splint, crutches, f/u in <7 days.
+**Severe pain, swelling, ecchymosis; inability to bear weight
-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==
+===Management===
-#soft tissue problems
+*Stable joint and ability to bear weight:
-##synovial impingement syndromes
+**NSAIDs, RICE (rest, ice, compression, elevation)
-##loose bodies in the joint
+**1 week f/u if no improvement
-##proneal tendon subluxation
+*Stable joint but unable to bear weight:
-#bony problems
+**Ankle brace w/ f/u in 1wk
-##osteochondral Fx of talar dome
+*Unstable joint
-##lateral or posterior fx of talus
+**Posterior mold splint and ortho consult/referral
-##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
 ==See Also==
@@ Line 55: / Line 52: @@
 *[[Ottowa Ankle Rules]]
 *[[Pilon Fx]]
+==Source==
+*Tintinalli
 [[Category:Ortho]]