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AssessmentAndManagementOfAnkleSprains

StevenSchepensM.D.AnkleSprainsMostcommonathleticinjuryMostcausedbyexcessiveinversionInjurytolateralsupportingligamentMosttreatednonoperativelyRiskOfAnkleInjuriesBySportBasketball----45%Soccer--------31%Volleyball---25%Football------10-15%LigamentousStructuresOfTheAnkle1)TibiofibularComplex2)MedialComplex3)LateralComplexLigamentousStructuresOfTheAnkleTibiofibularComplexStabilizestheanklemortiseAllowslittlemovementbetweentibiaandfibulaOn-FieldManagementGoal--IdentifyseriousinjuryScreenfordeformitiesAxialtractionandrelocationNeurovascularassessmentWeightbearingStabilizationOn-FieldManagement“GoldenPeriod”BestopportunityforaccuratediagnosisNoswellingPainhassubsidedNoguardingAssessmentOfAnkleSprainHistoryHowdidithappen?Wheredoesithurt?Didthepainmakeyoustopplaying?Wereyouabletobearweightrightaway?Haveyouinjuredthisortheotheranklebefore?AssessmentOfAnkleSprainPhysicalExamRemovalofshoesandsocksonbothfeetExamineuninjuredanklefirstPalpateligamentsandbonesandnoteanyswellingorecchymosisMovetheanklethroughsixrangesofmotion:Plantarflexion,dorsiflexion,andinversionandeversioninplantarflexionanddorsiflexionAssessmentOfAnkleSprainSpecificTestsAnteriorDrawerTestAssessestheintegrityoftheanteriortalofibularligamentLargenumberoffalsenegativesisassessedwithinthefirst48hours4-5dayspostinjuryhasasensitivityof86%andspecitivityof74%AssessmentOfAnkleSprainSpecificTestsThompson’sTestAchillestendonSqueezeTestExternalRotationTestSyndesmosisinjuriesAssessmentOfAnkleSprainRadiographsOttawaAnkleRules*WhenareankleX-raysnecessary:InabilitytobearweightBonetendernessonthetipofeithermalleolusorupto6cmuptheposterioredgeAnkleInjuryDifferentialLateralInversionSprainMostcommoninjury85%ofallanklesprainsLateralligamentsdamagedfromanteriortoposteriorGradingLateralAnkleSprainsMnemonicforTreatingAnkleSprainsP-rotectionR-estI-ceC-ompressionE-levationM-edicationM-obilizationMedialEversionSprainCommonlyseeninwrestlers10%ofsprainsvs.85%lateral75%ofanklefracturesoccuronmedialsideDeltoidLigamentSyndesmosisSprain1%-11%ofanklesprainsExternalrotationstressradiographsLittleswellingRecoverytimeof55daysBifurcateLigamentInjuryInjuryViolentDorsiflexion,Forcefulplantarflexion,directtrauma19%ofinversionsprainsAvulsionofanteriorprocessofcalcaneousNon-weight-bearingcastforfourweeksACHILLESTENDONRUPTURERapidplantarflexion2to6cmabovetheOsCalcisPeronealTendonInjurySubluxationordislocationPalpateoverthetendonwithdorsiflexionandeversionFlexorHallucisLongusInjuryOccurswithpeoplewhotiptoeorstandontheballsoftheirfeetLateralPeriostitisJumpersankleSymptomssimilartoalateralsprainLateralTalusAnteriorTi

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