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PTA 230 (Ortho) > CH 17: Ligament injuries of ankle > Flashcards

CH 17: Ligament injuries of ankle Flashcards

1
Q

What type of injury accounts for approximately for 14-25% of all sports-related injuries?

A

Injuries to lateral ligament complex (anterior/posterior talofibular ligament, fibulocalcaneal ligament)

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2
Q

What is the most common sports and orthopedic injuries?

A

Inversion ankle sprains

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3
Q

Where do approximately 95% of all ankle sprains occur?

A

Lateral ligament complex

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4
Q

What may untreated ankle sprains lead to?

A
  • Chronic pain
  • Muscular weakness
  • Instability
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5
Q

What type of sprain are usually caused by plantar flexion, inversion, and adduction of foot and ankle?

A

Ligament sprains of lateral aspect of ankle

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6
Q

What type of forces are needed to produce an ankle sprain?

A

Not a large force

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7
Q

Stepping off a curb, stepping into a small hole, or stepping on a rock can cause?

A

Sudden plantar flexion and inversion motions (lateral ligament sprain)

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8
Q

What commonly occurs when the foot is in an “unloaded” or non-weight bearing position before injury?

A

Ankle sprains (lateral ligament)

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9
Q

What is the most common occurrence during athletic competition that leads to lateral ligament sprains of the ankle?

A

Stepping on an opponent’s foot

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10
Q

What type of ligament rupture classifies as a single ligament rupture of the anterior talofibular ligament being completely torn?

A

1st degree sprain (lateral ligament)

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11
Q

What type of ligament rupture classifies as a double ligament rupture of anterior talofibular and fibulocalcaneal ligaments are completely torn?

A

2nd degree sprain (lateral ligament)

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12
Q

What type of ligament rupture classifies as all three lateral ankle ligaments completely torn (anterior/posterior talofibular and fibulocalcaneal ligaments)?

A

3rd degree sprain (lateral ligament)

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13
Q

What is required to ensure understanding of treatment progression and injury prognosis?

A

Use of a classification system to describe severity or complexity of ankle injuries

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14
Q

What is typically used by the PT to identify and quantify the integrity of lateral ligament complex?

A

Ankle stability tests

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15
Q

What test assesses an injury to anterior talofibular ligament?

A

Anterior drawer test

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16
Q

How does one perform the anterior drawer test?

A
  • 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
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17
Q

What is the inversion stress test that examines the resistance of the ankle ligament to maximal inversion stress?

A

Talar tilt test

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18
Q

An inversion ankle sprain occurs to what ligaments?

A

Lateral ligament complex (anterior/posterior talofibular, fibulocalcaneal ligament)

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19
Q

What is the clinical stability tests that are used to assess inversion ankle sprain?

A
  • Anterior drawer test

- Talar tilt test

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20
Q

What are the MMT motions that are used to assess inversion ankle sprain?

A
  • DF
  • PF
  • INV
  • EV
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21
Q

What are the ROM that are used to assess inversion ankle sprain?

A

-AROM and PROM (DF, PF, INV, EV)

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22
Q

What are the palpations that are used to assess inversion ankle sprain?

A
  • Distal tibia-fibula
  • Lateral ligament ocmplex
  • Medial ligaments: deltoid ligament
  • Base of 5th metatarsal
  • Peroneal tendons
  • Achilles tendon
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23
Q

What are the observations that are used to assess inversion ankle sprain?

A
  • Any obvious deformity
  • Note area and degree of swelling
  • Evaluate complaints of pain
  • Any discoloration
  • Perform bilateral visual comparison of symmetry
24
Q

What occurs in Phase I (Maximum-Protection Phase) for Intervention Program for Inversion Ankle Sprains?

A
  • 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
25
Q

What occurs in Phase II (Moderate-Protection Phase) for intervention program for inversion ankle sprains?

A
  • 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)
26
Q

What occurs in Phase III (minimum-protection phase) for intervention program for inversion ankle sprains?

A
  • Joint protection during activties
  • Running
  • Jumping
  • Plyometrics
  • Proprioception exercises
  • General fitness exercises
  • Isotonic exercises
  • Isokinetic exercises
27
Q

What is the initial management of an acute ankle inversion sprain?

A

RICE

28
Q

The application of ice, compression, and elevation is directed at?

A
  • Minimizing and reducing intense inflammation
  • Hemorrhage
  • Swelling
  • Pain
  • Cellular metabolism to provide most conducive environment for tissue healing
29
Q

What are the most effective means to reduce swelling?

A
  • Elevation

- Compression

30
Q

During the maximum protection phase (phase I) for inversion sprains, how many times should RICE be used?

A

3-5 times daily

-Ice : 15-20 min with 1-2 hour rest periods

31
Q

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?

A

Motion exercises

32
Q

When does the moderate-protection (Phase II) of inversion sprains begin?

A
  • Can bear weight on injured limb without crutches
  • Perform all ROM
  • Isometric exercises without undue complaints of pain
  • Control of swelling
33
Q

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?

A

Moderate protection phase (Phase II)

34
Q

When does the minimum-protection (Phase III) of inversion sprains begin?

A
  • Can perform all resistive exercises
  • Ambulate without pain or limping
  • Swelling is reduced
35
Q

How long can the maturation of injured ligaments take?

A

6-12 months

36
Q

What type of ankle sprains can be effectively managed nonoperatively with a supervised rehabilitation program?

A

First degree

Second degree

37
Q

How can grade III lateral ligament sprains be treated?

A

Surgically or with early controlled motion and supervised physical therapy

38
Q

What type of ligament injury requires longer joint protection?

A

Grade III

39
Q

Where can deleterious effects occur when ankle sprains are treated surgically and postoperative immobilization?

A
  • Bone
  • Muscle
  • Cartilage
  • Tendons
  • Ligaments
40
Q

What type of ligament sprain is rare?

A

Acute isolated sprains of deep and superficial layers of deltoid ligament (medial ligament)

41
Q

How often do deltoid (medial) ligament sprains occur?

A

3-5% of all ankle sprains

42
Q

When do complete deltoid (medial) ligament ruptures occur?

A

In combination with ankle fractures

43
Q

What types of problems do sprains of deltoid (medial) ligaments appear to lead to?

A
  • Posterior tibialis tendon dysfunction

- Chronic medial ankle instability

44
Q

What type of fractures may cause disruption of the deltoid (medial) ligaments?

A

Medial or lateral malleolus

45
Q

How are partial tears of deltoid (medial) ligaments managed?

A

-Nonoperatively with PT

46
Q

How are complete ruptures of deltoid (medial) ligaments managed since they typically occur with fractures?

A
  • Surgical repair and fixation of fracture fragments

- NWB for 6 weeks then progressive WB and PT

47
Q

What does rehabilitation focus on for the deltoid (medial) ligament?

A
  • Joint protection

- Use of semirigid orthosis

48
Q

What is the intervention (PT) for deltoid (medial) ligament sprains?

A
  • 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
49
Q

What occurs when the ankle is forced into dorsiflexion or rotation with foot in a weight bearing position?

A

Injury to ankle syndesmosis

50
Q

What type of injury is more prevalent in skiing, football, soccer, and other sport activities?

A

Injury to ankle syndesmosis

51
Q

What structure injuries supporting the ankle syndesmosis can result in an unstable distal tibiofibular articulation?

A
  • Anterior/Posterior tibiotalar ligaments
  • Interosseous membrane
  • Interosseous ligament
  • Deltoid ligament
52
Q

What type of diagnostic testing includes external rotation?

A

High ankle sprains (Ankle syndesmosis)

53
Q

What types of intervention treatments occur with high ankle sprain or ankle syndesmosis injury?

A
  • Immobilization
  • Limitation to WB
  • Surgery
  • Conservative treatment and rehabilitation secondary to WB being disruptive to healing process
54
Q

What can occur if high ankle sprain and ankle syndesmosis injury is mismanaged?

A
  • Chronic instability

- Arthritis

55
Q

How many patients have chronic symptoms of weakness, swelling, pain, and joint instability after inversion sprains?

A

10-30%

56
Q

What are the two types of instabilities associated with chronic ankle sprains?

A
  • Mechanical

- Functional

57
Q

What type of chronic ankle ligament instability is defined as laxity of the ankle ligaments?

A

Mechanical instabilities

PTA 230 (Ortho) (55 decks)

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