lecture 2

Question 1

ankle forced into eversion in dorsiflexed position=

Answer 1

eversion ankle sprain (10%)

deltoid ligament damaged

Question 2

the most injured ligament during ankle sprains

Answer 2

ATFL
(inversion sprain)

-plantarflexed position, ATFL already stretched and inversion will stretch it more!!

Question 3

high ankle sprains are more serious than

Answer 3

typical eversion/inversion sprains

Question 4

assessing ankle injuries

Answer 4

-history of current and past history
-compared w uninjured side
-observation
-ROM
-ligament test
-special tests
-palpation

Question 5

Contusion
SSx
DDx

Answer 5

traumatic bone bruise

SSx= pain, tenderness, discolouration (bleeding)

Tx= POLICE, padding, rehab

Question 6

Strain=

Answer 6

injury to muscle/tendon

Question 7

Sprain=

Answer 7

injury to ligament

Question 8

Ankle strain
SSx
Tx

Answer 8

SSx= pain, tenderness, may feel a snap, limp (2nd/3rd deg)

Tx= POLICE, tape, ROM, physio

Question 9

Tendinopathy
Hx
SSx
Tx

Answer 9

Hx= acute strain or overuse

SSx= tenderness, crepitus, swelling/bogginess

Tx= complete tendon rest!! (brace), NSAID, physio and ROM, tape, slow RTP

Question 10

degrees of ankle sprain

Answer 10

1st degree: partial tear
–> no snap, limp or incr laxity
POLICE

2nd degree: incomplete tear
–> snap/pop, increased laxity (has an end point)
POLICE, 2 days rest, xray?, cast, NSAID, physio, rehab

3rd degree: complete rupture
–> pos anterior drawer test for inversion, incr laxity, no firm end point on talar tilt test
Tx: stabilize (NPO), medical help, xray, surgery, cast, physio, rehab

Question 11

high ankle sprain symptoms

Answer 11

-forced into dorsiflexion w external rotation
-tenderness between distal tibia and fibulae
-anterior ankle swelling
-walking on toes to avoid painful dorsiflexion
-positive side to side talar tilt test (widened mortise)

Question 12

Xray findings of high ankle sprain

Answer 12

-incr tibiofibular (syndesmosis) clear space

-decreased tibiofibular overlap

-incr medial clear space

Question 13

What are some complications of ankle sprains? (5)

Answer 13

-recurrence

-chronic instability (mechanical:ligaments stretched or functional: impaired proprioceptive feedback)

-fracture

-dislocation

-subtalar joint injury (damage to cartilage in between bones)

Question 14

Functional instability: loss of proprioception

Answer 14

temporary= growth spurts, alcohol, concussion, fatigue, CNS injury

permanent= joint hypermobility, viral infection, brain injuries, parkinsons

Question 15

Assessing proprioception (4)

Answer 15

1. joint position matching
2. field sobriety test
3. romberg test
4. Y test or star excursion balance test (assesses chronic instability)

Question 16

ankle fracture evidence

Answer 16

history of severe trauma, deformity, bony tenderness, crepitus

Question 17

ankle fracture treatment

Answer 17

stabilize and transport, xray, reduction (surgery), cast, physio and rehab

Question 18

ankle injury rehab: phases (6)

Answer 18

1. activity modification/controlled weight bearing
   –> good to maintain partial weight to combat muscle atrophy, decr circulation, tendinitis
2. ROM
   –> minimize inversion/eversion initially
3. strengthening
   –> isometric, then isotonic

4.balance/proprioception
–> progression; eyes open, eyes closed etc.

5. Running progression
   –> pool running, walking, running on mini trampoline…
6. Return to sport
   –> walking drills, jogging drills…

Question 19

Criteria for return to sport (4)

Answer 19

1. full pain free ROM
   –> may take 10 weeks to restore
2. Normal strength
3. Normal proprioceptive function
4. Injured ligament healed
   –> may take at least 6 months

Question 20

when to use tape or brace?

Answer 20

• to prevent re-injury until rehab program is complete
  -proprioceptive stimulation benefits

Question 21

ankle plantar flexion and dorsiflexion: which joint?

Answer 21

talocrural joint

Question 22

peroneus longus and peroneus brevis assists with ankle…

Answer 22

eversion

Question 23

deltoid ligaments provide — stability of the ankle

Answer 23

provide most of the medial stability of the ankle preventing excessive eversion movement