Ankle sprain CPG Flashcards
Do lateral ankle sprains have a low or high incidence of re-injury?
High - up to ~30%
Which types of sports have higher incidence rates for lateral ankle sprain?
Court and team sports (soccer, basketball, football)
Which lateral ligament has the lowest load tolerance for stability in lateral ankle sprains?
Anterior talofibular ligament
Which ligament is the strongest lateral ligament?
Posterior talofibular ligament - provides rotary stability, rarely injured
Which two ligaments, when injured, contribute to anterolateral rotary instability of the ankle?
ATFL and deep interosseous ligament
Which type of instability is the result of excessive joint motion due to ligamentous disruption?
Mechanical instability
Which type of instability is a combination of sensorimotor and/or neuromuscular deficits, contributing to a feeling of instability with normal joint ROM?
Functional instability
Surgical intervention for lateral ankle sprains seems to positively affect feelings of instability, but produces early onset what?
Post-traumatic OA
Risk factors for injury/re-injury: (5)
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
What is considered a predictor for lateral ankle sprain?
Limited df ROM
Describe a Grade I ankle sprain:
No loss of function
Less than 5 deg ROM loss
No positive ligamentous testing (ATFL/CFL)
Swelling < 0.5 cm
Describe a Grade II ankle sprain:
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
Describe a Grade III ankle sprain:
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
What outcome assessment is most suggested for chronic ankle instability, and what is the MDC/MCID?
Cumberland Ankle Instability Tool (CAIT) - MDC/MCID = 3
What are two outcome measures suggested for use with lateral ankle sprains, and what are the MDC/MCID?
Foot and Ankle Ability Measure - MDC/MCID 6/12 - 8-9
LEFS - MCID 9
What are the Ottawa Ankle Rules: (5)
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
What are the Bernese Rules which make the Ottawa Ankle Rules more specific: (3)
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
In the star excursion test, what direction and distance places the patient at 2.5x more risk for a LE injury?
Anterior direction, > 4 cm difference
Is early progressive WB or immobilization better for acute ankle sprains?
Early, progressive, braced WB consistent with degree of injury - higher severity may require semi-rigid to casting
In subacute phases of recovery for lateral ankle sprains, what facets of outcome are affected by manual therapy? (3)
1) dorsiflexion ROM
2) proprioception
3) WB tolerance
Application of ice, esp in acute phases of lateral ankle sprains, decreases and improves what outcomes? (3)
1) pain
2) dec need for pain medication
3) improve WB
What modality is advocated against use in lateral ankle sprains?
Ultrasound
Is there better evidence for exercise in the acute or subacute phase of recovery with lateral ankle sprains?
Better for acute - weaker evidence in subacute phase, but still recommended to work on strength, ROM, proprioception
