Ankle Sprain Flashcards
Epidemiology of ankle sprain
- most common ankle joint injury
- Lateral ligament sprain most common of ankle sprains
- Indoor sports e.g. basketball carry greatest risk
What causes an ankle sprain? (Aetiology)
- Fall that causes ankle to twist
- Exercising on uneven surfaces
- Previous history of sprain
- Another person stepping or landing on foot
- Can occur from rapid shift of body mass over the wight bearing foot
Which ligament is most commonly injured in ankle sprain and how?
Anterior Talofibular Ligament (ATFL)
When plantar flexed foot is forcefully inverted
Which ligaments are least likely to get injured (ankle sprain)
Calcaneofibular (CFL) and Posterior Talofibular (PTFL)
How do medial sprains occur?
By forceful pronation and rotation movements of the hind foot
What are the signs of a sprained ankle?
- Pain (especially when bearing weight)
- Tenderness
-Bruising and swelling - Limited ROM
- Instability
Which special tests can be conducted for an ankle sprain?
Anterior drawer test, Talar tilt and Squeeze test
How is the Anterior drawer test conducted?
- Patient placed in prone position with ankle extending beyond bed
- Talofibular joint stabilised
- Heel held and anterior force applied
- Positive result: excessive anterior movement of foot and dimpling of skin besides achilles tendon
How is the talar tilt conducted?
- Patient seated
- Foot positioned in 10-20º plantarflexion
- Distal leg stabilised and hind foot inverted
- Positive result: significant inversion as compared to other foot
How is the squeeze test conducted?
- Compression of proximal fibula against the tibia
- Positive result: pain occurs indicating fracture or diastasis
Classification system of ankle sprain with imaging
Grade 1- slight stretching and damage to ligament
Grade 2- partial tear of ligament
Grade 3- complete rupture of ligament
Classification system of ankle sprain without imaging
Grade 1- mild impairment with minimal swelling and little impact on function
Grade 2- moderate impairment with moderate pain, swelling and tenderness. Decreased ROM and stability
Grade 3- severe impairment with significant swelling , loss of function and instability
How should a potential ankle sprain be assessed?
- take medical history
- observe gait, deformity, mal-alignment and swelling
- take note of tenderness
- assess passive and active ROM
What is the goal of treatment for an ankle sprain?
- decrease pain and swelling
- protect ligament from further injury
- restore function and stability
What is the common treatment protocol for an ankle sprain?
- PRICE
- Protection through crutches or brace or tape
What are the three stages of recovery? (ankle sprain)
- Inflammatory phase
- Proliferative phase
- Remodelling phase
What does the inflammatory phase of a sprain involve?
- reduce pain and swelling through PRICE and NSAIDs
- Provide support for joint
What does the proliferative phase of a sprain involve?
- occurs after swelling reduced
- improve weight bearing
- Increase ROM
- prevent further injury
- brace/tape can be used at the beginning of this phase to reduce further injury
What does the remodelling phase of a sprain involve?
- long-term process
- improve muscle strength, active stability, motion and mobility
- use of static and dynamic exercises
Which tests should be carried out to determine if you can return to normal activities? (ankle sprain)
- knee to wall test
- lower limb strength
- static balance test
- dynamic balance test
- agility test
