Ankle sprains Flashcards
Lateral ankle sprain overview
least stable in loose packed position, plantar flexion with inversion
Progression of severity from ATFL to CFL to PTFL
medial ankle sprains prevalence
Less common due to decreased eversion ROM and bony architecture
Grade one lateral ankle sprain
Mild symptoms
Likely kept playing
Microscopic tearing of ATFL
No functional loss or instability
Recovery time 2 to 10 days
Rarely seen in physical therapy you can self treat
Grade 2 lateral ankle sprain
Moderate functional loss
Involves ATFL and CFL
May have initially walked it off
Diffuse swelling and tenderness
Recovery time 10 to 30 days
Most commonly seen in physical therapy
Grade 3 lateral ankle sprain
Unstable multi ligamentous sprain
anterior capsular involvement
unable to fully weight bear
Diffuse edema and tenderness
Frequent concomitant fracture
Every time 30 to 90 days
Typically managed by ortho first
how do you test the grade one ankle sprain?
Anterior drawer
-A test for the ATFL (pain pr laxity)
-better diagnostic accuracy five days post injury, compared to two days post injury
talar tilt test
-for CFL
common sequelae of inversion ankle sprain
superficial peroneal nerve involvement
bony avulsion fx
-base of fifth MT
-Spiral fracture of fibula
-lateral maleoli
-navicular
Ottawa ankle rules
tenderness at
Posterior edge or tip of lateral malleolus
Base of fifth metatarsal
Posterior edge or tip of medial malleolus
navicular
medial/eversion sprain
much less common 5 to 10% of all ankle sprains
Strong deltoid ligament
More severe
Potential for mortice instability
medial malleolar fx
Localized pain over deltoid ligament
Positive eversion test (talar tilt)
syndesmotic sprain
injury to anterior tibiofibular ligament and or syndesmosis
Hyper Dorsiflexion
rotation and plantar flexion
Recovery greater than 6 months
Often surgical candidate
tests-
Syndesmotic squeeze
ER stress test
Fibular translation test
acute management for sprains
Initial pain and edema control RICE
Crutches - reduced WB
Early mobilization and WB
immobilization ?
immobilization after lateral ankle sprain
May be indicated in grade 3 injuries as well as syndesmotic injuries
Lead to protracted recovery in grade one and two injuries
Protected weight-bearing ideal, immediately post injury
Manual therapy for ankle sprain
Thrust and non-thrust techniques may improve pain and function following acute ankle sprain
therapeutic exercise
Strengthen evertors, Quads, hamstring, glutes
primary components of chronic ankle instability
Mechanical instability-pathologic laxity, impaired arthrokinematics, joint degenerative changes
Functional instability - altered neuromuscular control, strength deficits and deficient postural control
