Sprains Flashcards
What is the most common ligament injury?
- LAT ankle sprain inversion injury
- ANT talofibular ligament
What is the clinical biomechanical grading of sprains?
Mild = fibres overstretching
Moderate = rupture of fibres
Severe = total ligament rupture
What is a Grade 1 ligament sprain?
- localised palpation tenderness
- minimal swelling
- normal ROM / end feel (there is ligament resistance at end ROM)
- little functional deficit
What is a Grade 2 ligament sprain?
- notable palpation tenderness
- considerable swelling
- increased joint laxity
- +ve end feel (joint continues ROM but resists towards the end = still some fibres intact)
- moderate functional deficit (unable to perform ADL)
What is a Grade 3 ligament sprain?
- +/- audible pop
- immediate pain (then maybe none = nerve damage, no signals sent to CNS regarding pain
- significant palpation tenderness
- +/- major swelling (haemoarthrosis)
- significant joint laxity (no end feel)
- significant functional deficit
How are ankle sprain graded?
-ankle function
-joint testing
-ROM
-swelling
-pain
What is a Grade 1 ankle sprain?
- no point tenderness/loss of function
- little haemorrhaging (swelling)
- decreased total ankle ROM >5deg
- no ligament laxity (-ve ANT draw) (+ve talar tilt test)
What is a Grade 2 ankle sprain?
- point tenderness, some function loss
- swelling >0.5cm - <2cm
- decreased ROM >5deg - <10deg
- +ve ANT drawer test, -ve talar tilt test
What is a Grade 3 ankle sprain?
- extreme point tenderness
- haemorrhage
- total loss of function
- decrease ROM >10deg
- swelling >2cm
+ve ANT drawer test, -ve talar tilt test
How long is RTP/Rx for Grade 1 ankle sprain?
7-10days
How long is RTP/Rx for Grade 2 ankle sprain?
2-4WKS
How long is RTP/Rx for Grade 3 ankle sprain?
5-10WKS
What is a good indicator of ankle function/ healing?
30 calf raises 2-2 from floor
How do ligament sprains occur?
different loading/injury mechanisms, not restricted to any particular sports with twisting, jumping, landing, change of direction, tackling
What happens in a medial ankle sprain?
Injury to strong deltoid ligament
What are the causes of medial ankle sprains?
MED ankle sprains are less common than LAT ankle sprains.
- high forces. ligament damage with likely fractures due to high impact force causing rupture
What is the difference between partial and complete MED ankle sprains?
Partial (less serious): superficial damage to tibiocalcaneal, tibiospring, tibionavicular ligaments
Complete (more severe): deep damage to ANT tibiotalar, deep POS tibiotalar
What are high ankle sprains?
Located at tibiofibular syndesmosis
- rupture of tibiofibular syndesmosis
- caused by loaded dorsiflexion with EXT tibial ROT
- often occurs in running, twisting UB motion with sudden impact force (tackled)
What is the management of ankle sprains?
Stable - conservative management
Unstable - operative management
RTP conservative - 6-8wks
RTP surgical - >8wks
What happens with single isolated ligament sprains?
- injury localised to specific ligament e.g. ATFL or MCL
- conservative management used for ATFL/MCL injuries (even grade 3)
What happens with single major episodes of a ligament sprain?
-large functional deficits
-chronic sequalae (increased risk of developing OA)
Eg ACL rupture
- typically, ACL surgical reconstruction used
What is an example of multi-ligament damage?
ACJ caused by high impact forces
use Rockwood classification Type I-VI
Provide example of multi-ligament rupture with joint dislocation.
ankle dislocation
damage to ATFL, CFL PTFL + deltoid
knee dislocation
damage to ACL, PCL, MCL, LCL
