medial sprains and chronic ankle instability Flashcards
What are the causes of medial ankle sprain?
excessive EV
what are structures involved in medial ankle sprains
-Ligaments
*Deltoid
3 that connect Tibia with Talus, Calcaneus, and Navicular
Reinforces medial arch
other structures that maybe involved with medial ankle sprains are?
-Ligaments
*Subtalar or Talocalcaneal ligaments
Intraarticular: Posterior interosseous
Extraarticular: Medial Talocalcaneal
Medial sprains structured that are involved with bones?
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
What are medial Sprains symptoms?
-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
What are signs of medial sprains
-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
signs of the medial ankle
-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
what are syndesmotic sprains?
aka high ankle sprain
what are the causes of syndesmotic sprains?
primarily DF (Talus wider anteriorly than posteriorly) so excessive Talar posterior glide with ER aka peeling mechanism, possibly EV
what structures are involved with a syndesmotic sprain?
Ligaments in the following order
1st- AITFL
2nd- Interosseous membrane or syndesmosis
3rd- PITFL
4th- Deltoid ligs
Bone- Talar or distal Tibia/Fibular Fx
what are symptoms of a syndesmotic sprain
*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
What are this signs o syndesmotic sprains
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
signs of syndesmotic sprains?
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
What is chronic Ankle instability
-aka CAI
-Presence of functional or mechanical instability39
what are the risk factors of chronic ankle instability
-Increased talar curvature
-Lack of external support
-Lack of coordination training following a prior sprain
what are the causes of chronic ankle instability
-Past severe and/or recurrent sprain(s)
-80% re-injury rate following an IV sprain42
What are chronic ankle instability signs and symptoms
Possible acute S&S if aggravated39, 89 otherwise may be asymptomatic
What are chronic ankle instability signs and symptoms
-↓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
What are the PT Rx of a sprain?
90% successful25
POLICED
Possibly brief period of immobilization and/or assistive device11, 89
POLICED
Possibly brief period of immobilization and/or assistive device11, 89
what are PT Rx for sprains with modalities?
-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
PT RX for Bracing (sprains)
Bracing/Taping prn for protection/function
*Bracing- reduced risk11 and frequency22 but NOT severity with basketball22
PT Rx for sprains
*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
PT RX with MT
*STM including lymphatic drainage for swelling
*JM with MET
-ROM, proprioception, and tissue tolerances89
-AP talar mobes11
-Hypo analgesic effect and subsequent increased ROM
What is the MET for Sprains?
Ultimately for tissue proliferation (acute) and stabilization (acute and chronic)
what are MET for sprains?
Positional/Directional biases?
Lateral ankle sprain
Medial ankle sprain
High ankle sprain
PT RX for sprains; MET for Balance and Neuromuscular training11
-Prevents reoccurrences42
-Improved balance and inversion joint position sense, and greater motor neuron excitability (reaction time)
Prognosis to return to
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
Sprains
MD Rx-CAI Sx
*NO procedure is better than another
*Early functional rehabilitation appears superior to 6 wks immobilization in restoring early function
