CH 17: Ligament injuries of ankle Flashcards
What type of injury accounts for approximately for 14-25% of all sports-related injuries?
Injuries to lateral ligament complex (anterior/posterior talofibular ligament, fibulocalcaneal ligament)
What is the most common sports and orthopedic injuries?
Inversion ankle sprains
Where do approximately 95% of all ankle sprains occur?
Lateral ligament complex
What may untreated ankle sprains lead to?
- Chronic pain
- Muscular weakness
- Instability
What type of sprain are usually caused by plantar flexion, inversion, and adduction of foot and ankle?
Ligament sprains of lateral aspect of ankle
What type of forces are needed to produce an ankle sprain?
Not a large force
Stepping off a curb, stepping into a small hole, or stepping on a rock can cause?
Sudden plantar flexion and inversion motions (lateral ligament sprain)
What commonly occurs when the foot is in an “unloaded” or non-weight bearing position before injury?
Ankle sprains (lateral ligament)
What is the most common occurrence during athletic competition that leads to lateral ligament sprains of the ankle?
Stepping on an opponent’s foot
What type of ligament rupture classifies as a single ligament rupture of the anterior talofibular ligament being completely torn?
1st degree sprain (lateral ligament)
What type of ligament rupture classifies as a double ligament rupture of anterior talofibular and fibulocalcaneal ligaments are completely torn?
2nd degree sprain (lateral ligament)
What type of ligament rupture classifies as all three lateral ankle ligaments completely torn (anterior/posterior talofibular and fibulocalcaneal ligaments)?
3rd degree sprain (lateral ligament)
What is required to ensure understanding of treatment progression and injury prognosis?
Use of a classification system to describe severity or complexity of ankle injuries
What is typically used by the PT to identify and quantify the integrity of lateral ligament complex?
Ankle stability tests
What test assesses an injury to anterior talofibular ligament?
Anterior drawer test
How does one perform the anterior drawer test?
- Relaxed seated position
- Involved leg flexed to 90* at knee
- Involved ankle slightly plantarflexed
- Stabilize distal tibia and supported with one hand
- Grasp calcaneus gently and pull ankle forward
- No excessive motion= ligament intact
What is the inversion stress test that examines the resistance of the ankle ligament to maximal inversion stress?
Talar tilt test
An inversion ankle sprain occurs to what ligaments?
Lateral ligament complex (anterior/posterior talofibular, fibulocalcaneal ligament)
What is the clinical stability tests that are used to assess inversion ankle sprain?
- Anterior drawer test
- Talar tilt test
What are the MMT motions that are used to assess inversion ankle sprain?
- DF
- PF
- INV
- EV
What are the ROM that are used to assess inversion ankle sprain?
-AROM and PROM (DF, PF, INV, EV)
What are the palpations that are used to assess inversion ankle sprain?
- Distal tibia-fibula
- Lateral ligament ocmplex
- Medial ligaments: deltoid ligament
- Base of 5th metatarsal
- Peroneal tendons
- Achilles tendon
What are the observations that are used to assess inversion ankle sprain?
- Any obvious deformity
- Note area and degree of swelling
- Evaluate complaints of pain
- Any discoloration
- Perform bilateral visual comparison of symmetry
What occurs in Phase I (Maximum-Protection Phase) for Intervention Program for Inversion Ankle Sprains?
- RICE (rest, ice, compression, elevation)
- Electrical galvanic stimulation (EGS)
- Weight bearing as tolerated
- Joint protection (plastic, hinged orthosis, tape, air cast, semirgid braces)
- AROM (DF and EV)
- Isometric exercises
- General fitness exercises
What occurs in Phase II (Moderate-Protection Phase) for intervention program for inversion ankle sprains?
- RICE
- Full weight bearing
- Concentric and eccentric, contractors (band, ankle weights)
- Continued joint protection
- Heel cord stretching
- Stationary cycling
- Proprioception exercises
- General fitness exercises
- Avoidance of unwanted stress (INV, PF)
What occurs in Phase III (minimum-protection phase) for intervention program for inversion ankle sprains?
- Joint protection during activties
- Running
- Jumping
- Plyometrics
- Proprioception exercises
- General fitness exercises
- Isotonic exercises
- Isokinetic exercises
What is the initial management of an acute ankle inversion sprain?
RICE
The application of ice, compression, and elevation is directed at?
- Minimizing and reducing intense inflammation
- Hemorrhage
- Swelling
- Pain
- Cellular metabolism to provide most conducive environment for tissue healing
What are the most effective means to reduce swelling?
- Elevation
- Compression
During the maximum protection phase (phase I) for inversion sprains, how many times should RICE be used?
3-5 times daily
-Ice : 15-20 min with 1-2 hour rest periods
What is important to help reduce pain and swelling as well as help to increase function of joint during the Maximum-protection (Phase I) of inversion sprains?
Motion exercises
When does the moderate-protection (Phase II) of inversion sprains begin?
- Can bear weight on injured limb without crutches
- Perform all ROM
- Isometric exercises without undue complaints of pain
- Control of swelling
What phase of the inversion sprain therapy encourages the use of RICE principle, full weight bearing, and continued ligament support with use of braces or tape?
Moderate protection phase (Phase II)
When does the minimum-protection (Phase III) of inversion sprains begin?
- Can perform all resistive exercises
- Ambulate without pain or limping
- Swelling is reduced
How long can the maturation of injured ligaments take?
6-12 months
What type of ankle sprains can be effectively managed nonoperatively with a supervised rehabilitation program?
First degree
Second degree
How can grade III lateral ligament sprains be treated?
Surgically or with early controlled motion and supervised physical therapy
What type of ligament injury requires longer joint protection?
Grade III
Where can deleterious effects occur when ankle sprains are treated surgically and postoperative immobilization?
- Bone
- Muscle
- Cartilage
- Tendons
- Ligaments
What type of ligament sprain is rare?
Acute isolated sprains of deep and superficial layers of deltoid ligament (medial ligament)
How often do deltoid (medial) ligament sprains occur?
3-5% of all ankle sprains
When do complete deltoid (medial) ligament ruptures occur?
In combination with ankle fractures
What types of problems do sprains of deltoid (medial) ligaments appear to lead to?
- Posterior tibialis tendon dysfunction
- Chronic medial ankle instability
What type of fractures may cause disruption of the deltoid (medial) ligaments?
Medial or lateral malleolus
How are partial tears of deltoid (medial) ligaments managed?
-Nonoperatively with PT
How are complete ruptures of deltoid (medial) ligaments managed since they typically occur with fractures?
- Surgical repair and fixation of fracture fragments
- NWB for 6 weeks then progressive WB and PT
What does rehabilitation focus on for the deltoid (medial) ligament?
- Joint protection
- Use of semirigid orthosis
What is the intervention (PT) for deltoid (medial) ligament sprains?
- RICE (for pain and swelling)
- Isometric exercises
- Latex rubber band strengthening exercises
- AROM
- Progressive WBAT
- Total body fitness program can be initiated during cast immobilization and NWB
What occurs when the ankle is forced into dorsiflexion or rotation with foot in a weight bearing position?
Injury to ankle syndesmosis
What type of injury is more prevalent in skiing, football, soccer, and other sport activities?
Injury to ankle syndesmosis
What structure injuries supporting the ankle syndesmosis can result in an unstable distal tibiofibular articulation?
- Anterior/Posterior tibiotalar ligaments
- Interosseous membrane
- Interosseous ligament
- Deltoid ligament
What type of diagnostic testing includes external rotation?
High ankle sprains (Ankle syndesmosis)
What types of intervention treatments occur with high ankle sprain or ankle syndesmosis injury?
- Immobilization
- Limitation to WB
- Surgery
- Conservative treatment and rehabilitation secondary to WB being disruptive to healing process
What can occur if high ankle sprain and ankle syndesmosis injury is mismanaged?
- Chronic instability
- Arthritis
How many patients have chronic symptoms of weakness, swelling, pain, and joint instability after inversion sprains?
10-30%
What are the two types of instabilities associated with chronic ankle sprains?
- Mechanical
- Functional
What type of chronic ankle ligament instability is defined as laxity of the ankle ligaments?
Mechanical instabilities
