medial sprains and chronic ankle instability

Question 1

What are the causes of medial ankle sprain?

Answer 1

excessive EV

Question 2

what are structures involved in medial ankle sprains

Answer 2

-Ligaments
*Deltoid
3 that connect Tibia with Talus, Calcaneus, and Navicular
Reinforces medial arch

Question 3

other structures that maybe involved with medial ankle sprains are?

Answer 3

-Ligaments
*Subtalar or Talocalcaneal ligaments
Intraarticular: Posterior interosseous
Extraarticular: Medial Talocalcaneal

Question 4

Medial sprains structured that are involved with bones?

Answer 4

Bone
-Avulsion fx of medial malleolus
-Fx of lateral malleolus due to compression with excessive EV
-Epiphyseal plate- medial malleolus
-Muscles/Tendons- possible Tibialis Posterior strain and/or subluxation if flexor retinaculum torn

Question 5

What are medial Sprains symptoms?

Answer 5

-Sudden onset with trauma with foot turning outward
-Medial ankle P!/swelling
-Limited and P!ful ROM, especially turning outward
-Difficult and painful weight bearing

Question 6

What are signs of medial sprains

Answer 6

-Observation
*Swelling and possible ecchymosis
*Antalgic and asymmetrical gait
-Ottawa and Bernese Ankle Clinical Decision Rules (CDR)- determine need for radiographs89
-ROM- primary limited and P!ful EV
-Resisted/MMT- possible weak and P!ful IV

Question 7

signs of the medial ankle

Answer 7

-Special Tests- (+) medial ligamentous tests

-Talocrural: Generally, with Anterior and Reverse Anterior Drawer
Specific medial ligament tests for Deltoid ligaments

-Subtalar: Generally, with medial Calcaneal glide (higher sens/spec)
Specific with Posterior interosseous and medial lig tests

-TTP over involved structures

Question 8

what are syndesmotic sprains?

Answer 8

aka high ankle sprain

Question 9

what are the causes of syndesmotic sprains?

Answer 9

primarily DF (Talus wider anteriorly than posteriorly) so excessive Talar posterior glide with ER aka peeling mechanism, possibly EV

Question 10

what structures are involved with a syndesmotic sprain?

Answer 10

Ligaments in the following order
1st- AITFL
2nd- Interosseous membrane or syndesmosis
3rd- PITFL
4th- Deltoid ligs

Bone- Talar or distal Tibia/Fibular Fx

Question 11

what are symptoms of a syndesmotic sprain

Answer 11

*Sudden onset with trauma typically with ankle bent up
*Often anterior ankle P!/swelling
*Limited and P!ful ROM, especially bending ankle up
*Difficult and painful weight bearing

Question 12

What are this signs o syndesmotic sprains

Answer 12

Observation
*Swelling and possible ecchymosis
*Antalgic and asymmetrical gait
*Ottawa and Bernese Ankle Clinical Decision Rules (CDR)- determine need for radiographs89
*ROM- primary limited and P!ful DF and possibly EV
*Resisted/MMT- possibly weak and P!ful, no real specific direction

Question 13

signs of syndesmotic sprains?

Answer 13

Special Tests
(+) ligamentous tests
Inferior TibFib
Generally, with Reverse Posterior Drawer
Specific with Fibular ant/post translation (LR+ = 6.8; LR- = .2)
-Possibly same as medial sprain
*Single leg hop test if able- inability is MOST sens syndesmotic test

*TTP over involved structures

Question 14

What is chronic Ankle instability

Answer 14

-aka CAI
-Presence of functional or mechanical instability39

Question 15

what are the risk factors of chronic ankle instability

Answer 15

-Increased talar curvature
-Lack of external support
-Lack of coordination training following a prior sprain

Question 15

what are the causes of chronic ankle instability

Answer 15

-Past severe and/or recurrent sprain(s)
-80% re-injury rate following an IV sprain42

Question 16

What are chronic ankle instability signs and symptoms

Answer 16

Possible acute S&S if aggravated39, 89 otherwise may be asymptomatic

Question 17

What are chronic ankle instability signs and symptoms

Answer 17

-↓ed postural stability/proprioception39, 89 and plantar sensation127, 133
-Altered muscle activation patterns39, 89
-Aberrant joint motion39, 89
-Fibula is significantly more lateral from tibia120… could use a caliper to measure

Question 18

What are the PT Rx of a sprain?

Answer 18

90% successful25

Question 19

POLICED
Possibly brief period of immobilization and/or assistive device11, 89

Answer 19

POLICED
Possibly brief period of immobilization and/or assistive device11, 89

Question 20

what are PT Rx for sprains with modalities?

Answer 20

-Cryotherapy benefits with P!, swelling, needing less meds, and gait11, 89
-Weak evidence for diathermy and LASER11, 89, 129
-Conflicting evidence for electrotherapy11, 89
-US should NOT be used with acute sprains11, 89
-Acupuncture- conflicting evidence11

Question 21

PT RX for Bracing (sprains)

Answer 21

Bracing/Taping prn for protection/function

*Bracing- reduced risk11 and frequency22 but NOT severity with basketball22

Question 22

PT Rx for sprains

Answer 22

*Standard- mechanical support significantly decreased after 30 minutes of exercise21

*Talar technique to limit anterior glide

*Distal Tib Fib Technique
-Indication: high ankle sprains
-Limits separation and anterior distal fibular glide

Question 23

PT RX with MT

Answer 23

*STM including lymphatic drainage for swelling

*JM with MET
-ROM, proprioception, and tissue tolerances89
-AP talar mobes11
-Hypo analgesic effect and subsequent increased ROM

Question 24

What is the MET for Sprains?

Answer 24

Ultimately for tissue proliferation (acute) and stabilization (acute and chronic)

Question 25

what are MET for sprains?

Answer 25

Positional/Directional biases?
Lateral ankle sprain
Medial ankle sprain
High ankle sprain

Question 26

PT RX for sprains; MET for Balance and Neuromuscular training11

Answer 26

-Prevents reoccurrences42
-Improved balance and inversion joint position sense, and greater motor neuron excitability (reaction time)

Question 27

Prognosis to return to

Answer 27

Grade I: 1-2 weeks40
Avg. 7.2 days with track and field athletes

Grade II: 2-6 weeks40
Avg. 15 days with track and field athletes

Grade III
> 6 weeks40
Avg. 30-55 days with track and field athletes146

Question 28

Sprains
MD Rx-CAI Sx

Answer 28

*NO procedure is better than another

*Early functional rehabilitation appears superior to 6 wks immobilization in restoring early function