lecture 2 Flashcards
ankle forced into eversion in dorsiflexed position=
eversion ankle sprain (10%)
deltoid ligament damaged
the most injured ligament during ankle sprains
ATFL
(inversion sprain)
-plantarflexed position, ATFL already stretched and inversion will stretch it more!!
high ankle sprains are more serious than
typical eversion/inversion sprains
assessing ankle injuries
-history of current and past history
-compared w uninjured side
-observation
-ROM
-ligament test
-special tests
-palpation
Contusion
SSx
DDx
traumatic bone bruise
SSx= pain, tenderness, discolouration (bleeding)
Tx= POLICE, padding, rehab
Strain=
injury to muscle/tendon
Sprain=
injury to ligament
Ankle strain
SSx
Tx
SSx= pain, tenderness, may feel a snap, limp (2nd/3rd deg)
Tx= POLICE, tape, ROM, physio
Tendinopathy
Hx
SSx
Tx
Hx= acute strain or overuse
SSx= tenderness, crepitus, swelling/bogginess
Tx= complete tendon rest!! (brace), NSAID, physio and ROM, tape, slow RTP
degrees of ankle sprain
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
high ankle sprain symptoms
-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)
Xray findings of high ankle sprain
-incr tibiofibular (syndesmosis) clear space
-decreased tibiofibular overlap
-incr medial clear space
What are some complications of ankle sprains? (5)
-recurrence
-chronic instability (mechanical:ligaments stretched or functional: impaired proprioceptive feedback)
-fracture
-dislocation
-subtalar joint injury (damage to cartilage in between bones)
Functional instability: loss of proprioception
temporary= growth spurts, alcohol, concussion, fatigue, CNS injury
permanent= joint hypermobility, viral infection, brain injuries, parkinsons
Assessing proprioception (4)
- joint position matching
- field sobriety test
- romberg test
- Y test or star excursion balance test (assesses chronic instability)
ankle fracture evidence
history of severe trauma, deformity, bony tenderness, crepitus
ankle fracture treatment
stabilize and transport, xray, reduction (surgery), cast, physio and rehab
ankle injury rehab: phases (6)
- activity modification/controlled weight bearing
–> good to maintain partial weight to combat muscle atrophy, decr circulation, tendinitis - ROM
–> minimize inversion/eversion initially - strengthening
–> isometric, then isotonic
4.balance/proprioception
–> progression; eyes open, eyes closed etc.
- Running progression
–> pool running, walking, running on mini trampoline… - Return to sport
–> walking drills, jogging drills…
Criteria for return to sport (4)
- full pain free ROM
–> may take 10 weeks to restore - Normal strength
- Normal proprioceptive function
- Injured ligament healed
–> may take at least 6 months
when to use tape or brace?
- to prevent re-injury until rehab program is complete
-proprioceptive stimulation benefits
ankle plantar flexion and dorsiflexion: which joint?
talocrural joint
peroneus longus and peroneus brevis assists with ankle…
eversion
deltoid ligaments provide — stability of the ankle
provide most of the medial stability of the ankle preventing excessive eversion movement
