Ankle sprain: Difference between revisions
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**Assoc w/ hyperdorsiflexion when talus moves superiorly and separates tibia/fibula | **Assoc w/ hyperdorsiflexion when talus moves superiorly and separates tibia/fibula | ||
**Pain just above talus | **Pain just above talus | ||
==Differential Diagnosis== | |||
==Diagnosis== | ==Diagnosis== | ||
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**Inversion at the ankle causes tilting/lifting of the mortise joint | **Inversion at the ankle causes tilting/lifting of the mortise joint | ||
==Classification== | ===Classification=== | ||
*Grade I | *Grade I | ||
**No tearing of ligaments | **No tearing of ligaments | ||
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*Unstable joint | *Unstable joint | ||
**[[Splinting#Lower Extremity|Posterior mold splint]] and ortho consult/referral | **[[Splinting#Lower Extremity|Posterior mold splint]] and ortho consult/referral | ||
==Disposition== | |||
*Outpatient | |||
==See Also== | ==See Also== | ||
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*[[Ottowa Ankle Rules]] | *[[Ottowa Ankle Rules]] | ||
== | ==References== | ||
*Tintinalli | *Tintinalli | ||
*American Orthopaedic Foot and Ankle Society (September 2012) - http://orthoinfo.aaos.org/topic.cfm?topic=a00150 | *American Orthopaedic Foot and Ankle Society (September 2012) - http://orthoinfo.aaos.org/topic.cfm?topic=a00150 | ||
[[Category:Orthopedics]] | [[Category:Orthopedics]] | ||
Revision as of 11:39, 1 April 2016
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
Differential Diagnosis
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; 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
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
Disposition
- Outpatient
See Also
References
- Tintinalli
- American Orthopaedic Foot and Ankle Society (September 2012) - http://orthoinfo.aaos.org/topic.cfm?topic=a00150