Ankle sprain: Difference between revisions
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==See Also== | ==See Also== | ||
*[[Ankle Fracture]] | |||
*[[Ankle Fracture (Peds)]] | |||
*[[Maisonneuve]] | *[[Maisonneuve]] | ||
*[[Ottowa Ankle Rules]] | |||
*[[Pilon Fx]] | *[[Pilon Fx]] | ||
[[Category:Ortho]] | [[Category:Ortho]] |
Revision as of 18:14, 4 July 2011
Background
stress tests-best done several days after injury.
anterior drawer- tests the anterior talar fibular ligament (ATFL). knee at 90 degrees, foot in relaxed position. cup heel with one hand and push on tibia posteriorly-positive is 2mm of subluxation relative to the other foot or visible dimpling of the anterior skin.
Talar tilt- tests ATFL and calcaneofibular ligament (CFL)-in same position as above-forced inversion of foot is applied- positive if there is obvious joint laxity relative to the other side or no passive resistance to forced motion-indicates rupture of ATFL and CFL. can do with forced eversion which tests the stability of the deltiod ligament.
Fibular compression: tests the tiobiofibular syndesmotic ligament. Same position as before but dorsiflex foot. squeeze tibia and fibula together 6-8 inches below knee. Positive tests if there is pain in the ankle.
Thompson's tests- prone with knee flexed squeeze gastroc and soleus in midcalf. if no plantarflexion-torn achilles tendon.
Classification
- Class I
- mild pain,swelling can bear weight, negative stress test-
- Treatment = RICE and f/u in 7 days.
- Class II
- mod pain, swelling, difficulty bearing weight, pos ant drawer (4-14 mm), pos talar tilt (5-15 degrees)
- Treatment: rigid splint, crutches, <7 day f/u.
- Class III
- severe pain, unable to bear weight, lot of swelling. ant drawer >15 mm, talar tilt >15 degrees
- Treatment: rigid splint, crutches, f/u in <7 days.
ATFL most common ligament (80% of inversion injuries).
eversion injuries- deltoid ligament rarely isolated tear-usually avulsion Fx of medial malleolus. syndesmotic sprains more common than deltoid injuries (and more easily missed).
grade 2 and 3 eversion injuries are often placed in a short leg walking cast for 6-8 weeks.
Causes of Chronic Pain after Healing
- soft tissue problems
- synovial impingement syndromes
- loose bodies in the joint
- proneal tendon subluxation
- bony problems
- osteochondral Fx of talar dome
- lateral or posterior fx of talus
- anterior fx of calcaneus
Syndesmotic Sprain
(High Ankle)
Diagnosis
- Positive squeeze test
- TTP distal tibiofibular joint
Treatment
- Treat as sprain, f/u ortho/sports
- possible surgical repair if refractory to conservative management