Ankle sprain: Difference between revisions
Neil.m.young (talk | contribs) (Text replacement - "fx " to "fracture ") |
(Text replacement - "f/u" to "follow up") |
||
Line 52: | Line 52: | ||
*Stable joint and ability to bear weight: | *Stable joint and ability to bear weight: | ||
**NSAIDs, RICE (rest, ice, compression, elevation) | **NSAIDs, RICE (rest, ice, compression, elevation) | ||
**1 week | **1 week follow up if no improvement | ||
*Stable joint but unable to bear weight: | *Stable joint but unable to bear weight: | ||
**Ankle brace with | **Ankle brace with follow up in 1wk | ||
*Unstable joint | *Unstable joint | ||
**[[Splinting#Lower Extremity|Posterior mold splint]] and ortho consult/referral | **[[Splinting#Lower Extremity|Posterior mold splint]] and ortho consult/referral |
Revision as of 11:05, 12 July 2016
Background
Ankle stabilization anatomy
- 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 fracture or syndesmosis injury
- Always rule-out Maisonneuve fracture 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
Other Ankle Injuries
Distal Leg Fracture Types
- Tibial plateau fracture
- Tibial shaft fracture
- Pilon fracture
- Maisonneuve fracture
- Tibia fracture (peds)
- Ankle fracture
- Foot and toe fractures
Foot and Toe Fracture Types
Hindfoot
Midfoot
Forefoot
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 follow up if no improvement
- Stable joint but unable to bear weight:
- Ankle brace with follow up in 1wk
- Unstable joint
- Posterior mold splint and ortho consult/referral
Disposition
- Outpatient
See Also
References
- American Orthopaedic Foot and Ankle Society (September 2012) - http://orthoinfo.aaos.org/topic.cfm?topic=a00150