Ankle sprain: Difference between revisions

Revision as of 22:34, 25 August 2014

Ankle stabilization:
- Syndesmosis
- Ligaments
  - Medial: Medial collateral (deltoid) ligament (tibia to talus and calcaneus)
  - Lateral: Anterior/posterior talofibular, calcaneofibular ligaments

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

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

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; possible instability
- Increased pain, swelling, ecchymosis; difficulty bearing weight
- Immoblize with air splint; PT with ROM/stretching/strengthening exercises
Grade III
- Complete ligament tear; significant instability
- Severe pain, swelling, ecchymosis; inability to bear weight
- Immobilization and possible surgery; PT same as grade 2 but longer time period

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

Tintinalli
American Orthopaedic Foot and Ankle Society (September 2012) - http://orthoinfo.aaos.org/topic.cfm?topic=a00150

Authors:

@@ Line 32: / Line 32: @@
 **No splinting/casting; weight bearing as tolerated, isometric exercises, full ROM and stretching/strengthening exercises
 *Grade II
-**Partial ligament tear
+**Partial ligament tear; possible instability
 **Increased pain, swelling, ecchymosis; difficulty bearing weight
 **Immoblize with air splint; PT with ROM/stretching/strengthening exercises
 *Grade III
-**Complete ligament tear
+**Complete ligament tear; significant instability
 **Severe pain, swelling, ecchymosis; inability to bear weight
 **Immobilization and possible surgery; PT same as grade 2 but longer time period