Ligament injuries Flashcards
What are Ottawa rules for determining whether an ankle needs x-ray following suspected ligament injury?
Pain in the malleolar zone, plus:
- Tenderness over posterior edge/tip of lateral malleolus
- Tenderness over posterior edge/tip of medial malleolus
- Inability to weight bear both immediately after injury and now
What are Ottawa rules for considering X-ray of foot for suspected ligament injury?
Pain in midfoot zone, plus:
- Tenderness over navicular
- Tenderness over base of 5th metatarsal
- Inability to weight-bear both immediately adter and now
What other structures would you want to assess in an ankle ligament injury?
Palpate
- Deltoid ligament
- LAteral ligament complex
- Fibula up to knee - head of fibula fracture
- Squeeze test - syndesmosis
- Weight bearing
How would you manage an ankle ligament injury?
- Apply ice pack - 20 mins
- Crutches
- Analgesia
- Advice
What advice would you give someone with an ankle ligament injury?
- NSAIDs
- RICE
- Mobilise and weight bear as able
- Fully weight bear for 2 mins twice per day for a month
- Physio if not better after 1-2 weeks
How long does it take for a ligament stretch with microscopic tearing to heal?
2-4 weeks
What are clinical features of ankle ligament stretch with microscopic tearing?
- Local tenderness
- Minimal swelling
- No joint instability
What are clinical features for ankle ligament stretch with partial tearing?
- Local tenderness
- Oedema
- Ecchymosis
- Partial loss of joint motion - definite end point
How long does it take to heal an ankle ligament stretch with partial tearing?
4-12 weeks
What specific management would you use for ankle ligament stretch with partial tearing?
Stirrup splint - 4 weeks
What are clinical features of complete rupture of ankle ligament?
- Marked swelling
- Severe pain
- Gross ankle instability
How would you manage complete ligament rupture of the ankle?
- Aircast boot - 6 weeks
- Consider surgical management
How long would it take an ankle ligamnet rupture to heal?
3-6 months
What are the ottawa rules for knee ligament injuries which require X-ray?
- Age > 55 years
- Inability to weight bear both immediately after and now
- Isolated patellar tenderness
- Head of fibula tenderness
- Inability to flex to 90o
Why might you need to ask someone to return in a week to have a suspected knee ligament injury examined?
May be difficult to determine extent as may be to painful to examine - allow a week then fully examine
How would you generally manage someone with suspected knee ligament injury?
- Apply ice pack for 20 mins
- Crutches
- Analgesia
- Advice
What advice would you give someone with a knee ligament injury?
- NSAIDs
- RICE
- Mobilise and weight bear as able
- Try to fully weight ebar for 2 mins twice per day for a month
- Physio if not better after 1-2 weeks
What are the components of RICE?
- Rest
- Ice - 20 minutes 4 times per day
- Compression - elasticated bandage
- Elevation for 24 hours
Ibuprofen as well
What are features of a knee ligament stretch with microscopic tearing?
- Knee stable on clinical testing
- Tenderness
What specific management would you use for a knee ligament stretch with microscopic tearing?
Elastic or wool + crepe bandage for 2 weeks
How long does it take for knee ligament stretch with microscopic tearing take to heal?
2-4 weeks
What are clinical findings of knee ligament stretch with partial tearing?
- Laxity but definite end point
- Tenderness
How would you manage a knee ligament stretch with partial tearing?
Knee brace - 4 weeks or until no laxity
How long does it take for knee ligament stretching with partial tearing to heal?
4-12 weeks
What are clinical features of complete knee ligament rupture?
Joint opens > 1cm
How would you manage complete rupture of medial/collateral knee ligament?
Knee brace - 6-12 weeks or until no laxity
How would you manage complete rupture of anterior/posterior cruciate knee ligament?
Cast and surgical reconstruction
What are clinical features of damage to the menisci?
- Knee gives way
- Clicks or locks
How would you manage a damaged meniscus?
Arthroscopic repair - if locked or no better after 2 weeks
