Assessment And Management Of Ankle SprainsAnkle SprainsnMost common athletic injurynMost caused by excessive inversionInjury to lateral supporting ligamentnMost treated nonoperativelyRisk Of Ankle Injuries By SportnBasketball- 45%nSoccer- 31%nVolleyball- 25%nFootball- 10 - 15% Ankle Consists Of Two Joints nTalar MortiseAllows for plantar flexion and dorsiflexionnSubtalar JointAllows for inversion, eversion, and internal and external rotationLigamentous Structures Of The Anklen1) Tibiofibular Complexn2) Medial Complexn3) Lateral ComplexLigamentous Structures Of The AnklenTibiofibular ComplexStabilizes the ankle mortiseAllows little movement between tibia and fibula Ligamentous Structures Of The AnklenMedial ComplexDeltoid LigamentnLimits eversionnLimits lateral displacement of the talusMedial malleolus will often fracture before this ligament tears*Ligamentous Structures Of The AnklenLateral ComplexAnterior Talofibular*CalcaneaofibularPosterior TalofibularnResists internal rotation, anterior displacement, and inversionSecondary StabilizersnMuscles and TendonsPeroneous LongusAnterior TibialisPosterior TibialisAchilles tendonOn-Field ManagementnGoal-Identify serious injuryScreen for deformitiesnAxial traction and relocationNeurovascular assessment Weight bearingStabilizationOn-Field Managementn“Golden Period”Best opportunity for accurate diagnosisNo swelling Pain has subsidedNo guardingAssessment Of Ankle SprainnHistoryHow did it happen?Where does it hurt?Did the pain make you stop playing?Were you able to bear weight right away?Have you injured this or the other ankle before?Assessment Of Ankle SprainnPhysical ExamRemoval of shoes and socks on both feetExamine uninjured ankle firstPalpate ligaments and bones and note any swelling or ecchymosisMove the ankle through six ranges of motion:nPlantar flexion, dorsiflexion, and inversion and eversion in plantar flexion and dorsiflexionAssessment Of Ankle SprainnPhysical ExamStrength testing (compare to other ankle)Special tests for joint stabilityAssessment Of Ankle SprainnSpecific TestsAnterior Drawer TestnAssesses the integrity of the anterior talofibular ligamentnLarge number of false negatives is assessed within the first 48 hoursn4 - 5 days postinjury has a sensitivity of 86% and specitivity of 74%Assessment Of Ankle SprainnSpecific TestsTalar Tilt TestnDeltoid ligament- eversionnCalcaneofibular- inversionSide-to-side TestnTibiofibular ligament93% specific Assessment Of Ankle SprainnSpecific TestsThompsons TestnAchilles tendonSqueeze TestExternal Rotation TestnSyndesmosis injuries Assessment Of Ankle SprainnRadiographsOttawa Ankle Rules*When are ankle X-rays necessary:nInability to bear weightnBone tenderness on the tip of either malleolus or up to 6cm up the posterior edge Assessment Of Ankle SprainnRadiographsOttawa Ankle Rules*When are foot X-rays necessary:nInability to bear weightnBone tenderness at the navicular or the base of the fifth metatarsaln100% sensitivityAnkle Injury DifferentialnLateral Inversion SprainMost common injury85% of all ankle sprainsLateral ligaments damaged from anterior to posteriorGrading Lateral Ankle SprainsMnemonic for Treating Ankle SprainsnP-rotectionnR-estnI-cenC-ompressionnE-levationnM-edicationnM-obilizationMedial Eversion SprainnCommonly seen in wrestlersn10% of sprains vs. 85% lateraln75% of ankle fractures occur on medial sidenDeltoid LigamentSyndesmosis Sprainn1% - 11% of ankle sprainsnExternal rotation stress radiographsnLittle swellingnRecovery time of 55 daysBifurcate Ligament InjurynInjuryViolent Dorsiflexion, Forceful plantar flexion, direct trauman19% of inversion sprainsnAvulsion of anterior process of calcaneousnNon-weight-bearing cast for four weeksACHILLES TENDON RUPTUREnRapid plantar flexionn2 to 6cm above the Os CalcisPeroneal Tendon InjurynSubluxation or dislocationnPalpate over the tendon with dorsiflexion and eversionFlexor Hallucis Longus InjurynOccurs with people who tiptoe or stand on the balls of their feetLateral PeriostitisnJumpers anklenSymptoms similar to a lateral sprainnLateral TalusAnterior Tibialis Tendon InjurynMost often in elderly peoplenFoot dropnSurgerySafe Return To PlaynStable or unstablenPain free range of motionnFunction testing pain free