Ankle sprain: Difference between revisions

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**Immobilization and possible surgery; PT same as grade 2 but longer time period
**Immobilization and possible surgery; PT same as grade 2 but longer time period


===Management===
==Management==
*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)

Revision as of 11:42, 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

Other Ankle Injuries

Distal Leg Fracture Types

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 f/u if no improvement
  • Stable joint but unable to bear weight:
    • Ankle brace w/ f/u in 1wk
  • Unstable joint

Disposition

  • Outpatient

See Also

References