Ankle sprain CPG

Question 1

Do lateral ankle sprains have a low or high incidence of re-injury?

Answer 1

High - up to ~30%

Question 2

Which types of sports have higher incidence rates for lateral ankle sprain?

Answer 2

Court and team sports (soccer, basketball, football)

Question 3

Which lateral ligament has the lowest load tolerance for stability in lateral ankle sprains?

Answer 3

Anterior talofibular ligament

Question 4

Which ligament is the strongest lateral ligament?

Answer 4

Posterior talofibular ligament - provides rotary stability, rarely injured

Question 5

Which two ligaments, when injured, contribute to anterolateral rotary instability of the ankle?

Answer 5

ATFL and deep interosseous ligament

Question 6

Which type of instability is the result of excessive joint motion due to ligamentous disruption?

Answer 6

Mechanical instability

Question 7

Which type of instability is a combination of sensorimotor and/or neuromuscular deficits, contributing to a feeling of instability with normal joint ROM?

Answer 7

Functional instability

Question 8

Surgical intervention for lateral ankle sprains seems to positively affect feelings of instability, but produces early onset what?

Answer 8

Post-traumatic OA

Question 9

Risk factors for injury/re-injury: (5)

Answer 9

1) hx of lateral ankle sprain
2) dec df ROM
3) lack of use of brace/external support
4) no tx after initial injury with propriocpetive training
5) lack of warm up with static/dynamic stretch etc

Question 10

What is considered a predictor for lateral ankle sprain?

Answer 10

Limited df ROM

Question 11

Describe a Grade I ankle sprain:

Answer 11

No loss of function
Less than 5 deg ROM loss
No positive ligamentous testing (ATFL/CFL)
Swelling < 0.5 cm

Question 12

Describe a Grade II ankle sprain:

Answer 12

Mild-moderate loss of function
Ecchymosis, point tenderness
Positive ATFL, but not CFL (talar tilt)
Between 5-10 deg ROM loss
Swelling of 0.5 cm to 2 cm

Question 13

Describe a Grade III ankle sprain:

Answer 13

Nearly complete loss of function
Loss of >10 deg of ROM
Positive ligamentous testing for both ATFL/CFL (drawer/tilt)
Swelling >2 cm
Inability to bear weight
Ecchymosis and severe point tenderness

Question 14

What outcome assessment is most suggested for chronic ankle instability, and what is the MDC/MCID?

Answer 14

Cumberland Ankle Instability Tool (CAIT) - MDC/MCID = 3

Question 15

What are two outcome measures suggested for use with lateral ankle sprains, and what are the MDC/MCID?

Answer 15

Foot and Ankle Ability Measure - MDC/MCID 6/12 - 8-9

LEFS - MCID 9

Question 16

What are the Ottawa Ankle Rules: (5)

Answer 16

1) tenderness 6 cm proximal to distal fib/lateral malleolus
2) tenderness of medial malleolus
3) tenderness over navicular
4) tenderness over proximal base of 5th
5) inability to WB 4 steps - limping counts

Question 17

What are the Bernese Rules which make the Ottawa Ankle Rules more specific: (3)

Answer 17

1) application of flat thumb/pressure over medial malleolus
2) compression of the midfoot to rear foot / sagittal application of force through midfoot on rear foot
3) compression midshaft fibula 10cm proximal to distal aspect

Question 18

In the star excursion test, what direction and distance places the patient at 2.5x more risk for a LE injury?

Answer 18

Anterior direction, > 4 cm difference

Question 19

Is early progressive WB or immobilization better for acute ankle sprains?

Answer 19

Early, progressive, braced WB consistent with degree of injury - higher severity may require semi-rigid to casting

Question 20

In subacute phases of recovery for lateral ankle sprains, what facets of outcome are affected by manual therapy? (3)

Answer 20

1) dorsiflexion ROM
2) proprioception
3) WB tolerance

Question 21

Application of ice, esp in acute phases of lateral ankle sprains, decreases and improves what outcomes? (3)

Answer 21

1) pain
2) dec need for pain medication
3) improve WB

Question 22

What modality is advocated against use in lateral ankle sprains?

Answer 22

Ultrasound

Question 23

Is there better evidence for exercise in the acute or subacute phase of recovery with lateral ankle sprains?

Answer 23

Better for acute - weaker evidence in subacute phase, but still recommended to work on strength, ROM, proprioception