Acute Ankle Conditions Flashcards
What is a Grade 1 acute ankle sprain?
mild stretching of the LCL of the foot
no joint instability is noted
what is a Grade 2 acute ankle sprain?
involves a ligament tear or partial rupture (usually ATFL)
mild instability noted
what is a Grade 3 acute ankle sprain?
complete disruption of the LCL complex AND instability of the ankle joint is seen
When completing an ankle exam after an acute injury, how should the physical exam be performed?
in a systematic and reproducible fashion, from proximal to distal.
why do you palpate the proximal fibula in an ankle exam after an acute injury?
to rule out a Maisonneauve fx
how do you evaluate the ankle syndesmosis?
external rotation and medial-to-lateral squeeze tests
the talar tilt test evaluates the integrity of what ligament?
CFL
explain how to perform the external rotation test to evaluate the syndesmosis.
stabilize the leg with one hand.
externally rotate the foot on the leg with the other hand.
if significant pain ensues, this is a positive finding.
explain how to perform the medial-to-lateral squeeze test to evaluate the syndesmosis.
the tibia and fibula are compressed together about 3cm proximal to the ankle joint. if pain ensues distally, this is considered a positive test.
explain how you would perform the talar tilt test.
hold the leg locked from side to side and invert the heel. can be performed under AP radiograph so that the angle btwn the tibia and talus can be measured. a difference of 5-15 deg btwn limbs is a significant disruption.
what are the Ottawa ankle rules for obtaining radiographs?
ankle radiographs are necessary if:
- pain at tip of medial malleolus
- pain at tip of lateral malleolus
- or inability to bear weight immediately / walk 4 steps in the ED
foot radiographs necessary if:
- bony tenderness at th navicular
- bony tenderness at base of 5th met
- or inability to bear weight immediately / walk 4 steps in the ED
how long does it take for ligaments of the ankle to heal?
6 weeks to 3 months
when evaluating for deltoid injury, a medial clear space of how much is considered abnormal?
> 4mm
What is the function of deltoid ligament ?
(prohibits abduction and eversion )
superficial deltoid- resists hindfood eversion
deep deltoid- prevents external rotation of the talus
what is the angular relationship between the CFL and ATFL?
104 deg
this is important to remember during reconstructive porcedures
what is the superficial part of the deltoid ligament?
tibiocalcaneal
tibionavicular
posterior tibiotalar
what is the deep part of the deltoid ligament?
anterior tibiotalar
the inferior transverse ligament is really part of waht ligament?
deep fibers of the PITFL
which ligament spans across both talocalcaneal and tibiotalar (ankle joint)?
CFL
Which ligament helps to check over-inversion?
cervical lig (anterior talocalcaneal)
If you suspect a severe complete sprain of the lateral ankle complex, what test can you order if MRI is unavailable?
arthrogram
what taping technique is most popular after an acute ankle sprain?
open basket weave technique
The classic article by Ramsey and Hamilton showed that if the talus is displaced by 1mm laterally, how much tibiotalar contact do you lose? Why is this important?
a. 42% decrease in tibiotalar contact area when talus is displaced 1mm laterally
b. Shows that if talus isn’t reduced back into the mortise, gross instability occurs post-traumatic arthritis
Why do you perform the external rotation test when evaluating for a syndesmotic injury?
because it is the external motion of the talus that usually causes syndesmotic injuries
