ankle sprains Flashcards
what percentage of individuals individual report pain, instability, restrain and full recovery at three years post grade II ankle sprain?
2-3 months every does better
- 5-25% pain @3 year
- 12-22% instability
- 20% resprain @3
- 55-85% fully recover
What are the patient subgroups of lateral ankle sprain for the clinical practice guideline
Acute/protected motion phase - enrolled in about 72 hours -signficant edema - limited weight bearing - evidence of overt gait deviation Progressive loading, sensorimotor training phase - enrolled greater than 72 hours - primary concern of functional instability - no gold stand test available
What are the primary ligament involved in lateral ankle sprains
ATFL ( oblique anterior) gives away first and CFL (vertical medial) is the secondary stabilizer after the ATFL give away
what neural structures are of secondary concern with lateral ankle sprains
superficial peroneal (across the top) and sural (lateral traveling under 5th met)
Describe the quality of evidence surrounding the acute phase DD of lateral ankle sprains
I- ottawa ankle rules for fracture
II - muscle strains
III - cuboid syndrome
IV - sydemosis, subtler and adjacent joint sprains
describe quality of DD of post acute phase
1 - chronic instability
II- accessory ossicles
III - tarsal coalition
IV - impingement, osteochondral lesions, sinus tarsi syndrome
what are the zones of palpation with the OAR
malleolar - 3-5cm of posterior edge of malleolus
mid foot - navicular and cubed, 5th met styloid process
what are functional risk factors for ankle sprains
I - abnormal gait, impaired posture, impaired proprioception, impaired reaction time
II - low aerobic fitness, decreased cutaneous sensation, decreased NCV
III - high self assess liability with hop testing
IV - low ankle strength, impaired balance
what are the structural risk factors for ankle sprains
I - cavus foot type, specific laxity
II- decreased ROM, general laxity, limb dominance, female, laxity in lateral ankle, lateral ankle laxity
III - unstable osseous joint configuration, taller talus in females
V 0 distal TB mechanics, PF position of the ankle during sprain, limited rotational stability
what the extrinsic risk factors for lateral ankle sprains
I - poor conditions, court or team based sports, ankle tape and orthosis decrease, warm-up decreases
II - level of competition, education, appropriate shoe type, slower self selected running speed
III - novice competition and understanding rules of the sport
What is the foot and ankle ability measure good for
region specific designed to assess activity limitations and participation restrictions with general foot MSK
- good content validity and retest reliability
What some evaluative patient self reported indexes have demonstrated validity for use in lateral ankle sprains
- foot and ankle ability measure
- LEFS
- ankle joint functional assessment tool
- chronic ankle instability scale (draw in affect)
- sport ankle rating (patient and clinical parts(
what are some discriminative patient self reported indexes with good validity for LAS
- ankle instability instrument
- cumberland ankle instability tool
- functional ankle instability questionnaire
what is a grade I sprain
- no loss of function
- no laxity
- little or no hemorrhaging
- no point tenderness
- swelling less than 0.5
- ROM loss less then 5 degree
grade II
- some loss of function
- postive AD test (ATFL)
- negative talar tilt (CF)
- hemorrhaging
- point tenderness
- decrease ROM 5-10 degree
- swelling 0.5 to 2.0 cm
grade III
- near total loss of function
- positive anterior drawer and talar tilt
- hemmoraging
- extreme tenderness
- greater than 10 deg ROM loss
- swelling greater than 2.0 cm
IIIa - stress radiograph (rear foot blocked into supination) movement les than 3 mm
IIIb - greater than 3 mm
Describe the data around the Anterior drawer test
- SPIN - .58-.80
- SNOUT - .77-.94
- +LR - 3-10 x more likely to have
- -LR .28-.45
data for talar tilt
- SPIN .5
- SNOUT .88
- +LR 4 x more likely
- -LR .57
What are the landmarks for figure of 8 measurement
- tips malleoli
- styloid of 5ht met
- navicular tuberosity
how do assess the transverse tarsal ROM
- seated with foot PF and measures along the tibia and length of foot
- move into inversion and eversion position
What is the balance progress with the BESS test
- eyes closed
- feet together, single leg, tandem then repeat on foam
- norm 11-15 error young, old 15-20
how do you perform a simple balance test
single leg stance hands on hips 1 minute
- number of errors eyes open and closed (B)
what are some validated functional measures of ankle sprains
- variety of hop tests (2x timed 5m figure 8, timed 10x side hop, timed 6m cross, timed square hop all planes, 3x lateral hop for distance, triple crossover)
- 40m walk or run for time
- shuttle run
- agility multiple hop test
How do your measure subtalar joint motion
Rear foot calcaneus motion
what manual techniques have demonstrated value in treating lateral ankle sprains
Manual lymph drainage
joint mobilization
What motions should you check prior to manipulation the cuboid
inversion and plantar flexion should be full
Describe he strength of evidence for acute and post acute phases
- acute - strong evidence fore exercise and rehab- grade A (strong agreement of literature
- post acute - therapeutic exercise conflicting evidence and clinical expertise (D and F strength)
how can you decrease pronation with ankle stretches
varus wedge of the forefoot
What modalities are most supported by the literature with acute lateral ankle sprains
- Cryo A -strong level - of support
- US grade recommendation to not use
- electro and laser - D - conflicting
- shortwave diathermy - C - weak
What does the literature indicate early weight bearing
Strong evidence of support grade A
Joint mobs and manipulation are most affective in what phase of LAS recovery
post acute - grade A - recommendation
what patients are most likely to benefit from manual therapy following lateral ankle sprain
- post acute
- worse symptoms with standing
- worse symptoms in the evening
- navicular drop test 5 mm or greater
- hypomobility of the distal tib/fib joint
How do we use CPGs in patient care
- identify risk factors
- DD
- interactions that are clinically effective and patient subgrouping
- prognosis
what are the primary risk factors for lateral ankle sprains
- history of ankle sprains
- do not use external support
- do not warm up properly
- do not have normal DF ROM
- do not participate in balance or proprioception prevention program
