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DPT 691 - MSK II > Sprains - Ankle > Flashcards

Sprains - Ankle Flashcards

1
Q

What is an ankle sprain, and how is it commonly caused ?

Ankle Sprains

A

An ankle sprain is an injury to the ligaments that support the ankle, often occurring when the ankle is twisted or turned in an awkward manner, resulting in overstretching or tearing of these ligaments.

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2
Q

Identify the three major types of ankle sprains discussed in clinical settings.

Ankle Sprains

A

The three major types of ankle sprains are lateral ankle sprains, chronic ankle instability, and syndesmotic (high) ankle sprains.

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3
Q

Why is it important for a healthcare provider to differentiate between different types of ankle sprains ?

Ankle Sprains

A

Differentiating between types of ankle sprains is crucial because each type may affect different ligaments, require specific diagnostic tests, and respond best to tailored treatment and rehabilitation strategies.

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4
Q

What are the general goals of managing ankle sprains in a clinical setting?

Ankle Sprains

A

The general goals of managing ankle sprains include reducing pain and swelling, restoring full range of motion, strengthening the muscles around the ankle to prevent future injuries, and ensuring a safe return to daily activities or sports.

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5
Q

Describe the general approach to the initial assessment of a suspected ankle sprain.

Ankle Sprains

A

The initial assessment of a suspected ankle sprain typically involves taking a detailed history of the injury event, observing the physical symptoms (like swelling and discoloration), and performing specific physical examinations and tests to assess the stability of the ankle and the integrity of its ligaments.

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6
Q

What is the most common type of ankle sprain?

Ankle Sprains

A

Lateral ankle sprains are the most common type of ankle trauma.

  • Most affected = Anterior talofibular ligament and Calcaneofibular ligament
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7
Q

Which ligaments are typically involved in a lateral ankle sprain?

Ankle Sprains

A

The ligaments involved include the anterior talofibular ligament , the calcaneofibular ligament , and the posterior talofibular ligament.

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8
Q

Describe the common mechanism of injury for a lateral ankle sprain.

Ankle Sprains

A

Lateral ankle sprains commonly occur due to ankle inversion and plantar flexion, often during activities like jumping or landing improperly.

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9
Q

What are the risk factors associated with lateral ankle sprains?

Ankle Sprains

A
  • Forced Plantar flexion and inversion movement.
  • New models also point toward inversion and internal rotation as primary forces
  • A previous episode of ankle sprain Young males in Sports 85% of patients
  • Rigorous sports with end range of motion, twisting, pivoting
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10
Q

What are common symptoms following a lateral ankle sprain?

Ankle Sprains

A

Symptoms typically include acute pain over the anterior lateral aspect of the ankle, swelling, bruising, and a popping sound at the time of injury.

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11
Q

Which special tests are used to diagnose lateral ankle sprains?

Ankle Sprains

A
  • Anterior Drawer test
  • Talar Tilt test
  • Reverse Anterior Drawer test
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12
Q

What initial treatment strategies are recommended for lateral ankle sprains?

Ankle Sprains

A

Initial treatments include bracing or casting for moderate to severe injuries, PRICE (protection, rest, ice, compression, elevation), and pain management techniques.

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13
Q

Describe the role of manual therapy in the treatment of lateral ankle sprains.

Ankle Sprains

A

Manual therapy may include joint mobilizations for dorsiflexion and subtalar mobility, as well as soft tissue techniques to the peroneal musculature and posterior chain.

  • Manual Therapy w/ Exercise was superior compared to HEP at 4 weeks and 6 months.
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14
Q

What are key elements of motor control rehabilitation for lateral ankle sprains?

Ankle Sprains

A

Rehabilitation should include protected range of motion activities, flexibility and strengthening exercises within a pain-free range, and the use of ankle weights and bands for mobility exercises.

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15
Q

Explain the importance of sensory training in the recovery from a lateral ankle sprain.

Ankle Sprains

A

Sensory training, such as balance retraining using equipment like rocker boards and wobble boards, helps in restoring control and preventing future sprains.

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16
Q

What grading system is used to classify the severity of lateral ankle sprains, and what are the criteria?

Ankle Sprains

A

Lateral ankle sprains are classified into

  • Grade I (no loss of function, minimal tenderness, and swelling)
  • Grade II (some loss of function, pain, and swelling, positive anterior drawer test)
  • Grade III (significant loss of function, severe pain, and swelling, positive drawer and talar tilt tests).
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17
Q

What are the expected recovery timelines for lateral ankle sprains based on their grading?

Ankle Sprains

A
  • Grade I sprains typically require about 7 days for recovery.
  • Grade II can take up to 15 days
  • Grade III may need 30 days or more depending on the severity and treatment efficacy.
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18
Q

Discuss the prognosis of lateral ankle sprains.

Ankle Sprains

A

While many individuals recover fully, up to 33% may experience symptoms at one year, and chronic issues like instability and stiffness can persist, particularly without adequate rehabilitation.

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19
Q

What are common complications associated with lateral ankle sprains?

Ankle Sprains

A
  • Chronic ankle instability
  • Recurrent sprains
  • Development of ankle impingement
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20
Q

How can lateral ankle sprains be prevented in athletes?

Ankle Sprains

A
  • The use of ankle support devices
  • Proper warm-up routines
  • Strength and balance training
  • Maintaining good flexibility and ankle ROM
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21
Q

What is CAI ?

Ankle Sprains

A
  • Chronic Ankle Instability (CAI) is a condition characterized by recurrent sprains and a persistent feeling of the ankle ‘giving way,’ typically as a result of inadequate healing or rehabilitation after an initial ankle sprain.
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22
Q

List the two types of instability described in cases of CAI.

Ankle Sprains

A

The two types of instability are mechanical pathological laxity and functional ankle instability.

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23
Q

What are the typical symptoms associated with Chronic Ankle Instability?

Ankle Sprains

A
  • Symptoms often include repeated episodes of instability, pain, and discomfort in the ankle, especially when involved in activities that require rapid changes in direction or uneven surfaces.
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24
Q

What risk factors contribute to the development of Chronic Ankle Instability?

Ankle Sprains

A
  • Risk factors include a history of repeated ankle sprains, decreased proprioceptive awareness, and participation in sports that involve jumping, twisting, or pivoting.
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25
Q

Which physical examination tests are useful in assessing Chronic Ankle Instability?

Ankle Sprains

A
  • Anterior Drawer test
  • Reverse Anterior Drawer test
  • Talar Tilt test
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26
Q

Describe the management strategies typically employed for Chronic Ankle Instability.

Ankle Sprains

A

Management strategies often include

  • Bracing to support the ankle during activities
  • Proprioceptive and balance training exercises
  • Possibly surgical intervention in severe cases
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27
Q

What role does proprioception training play in the rehabilitation of CAI?

Ankle Sprains

A

Proprioception training helps to improve the sensory feedback system of the ankle, enhancing stability and reducing the risk of re-injury by improving balance and joint position sense.

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28
Q

How does manual therapy contribute to the treatment of Chronic Ankle Instability?

Ankle Sprains

A

Manual therapy may include mobilizations and manipulations of the ankle and surrounding joints to improve mobility, reduce pain, and enhance functional movement patterns.

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29
Q

What are common rehabilitation exercises recommended for patients with CAI?

Ankle Sprains

A

Rehabilitation exercises typically focus on…

  • Strengthening the muscles around the ankle
  • Increasing ROM
  • Improving balance & proprioception (often using tools like balance and/or wobble boards).
30
Q

Potential long-term outcomes if Chronic Ankle Instability is not properly managed = ?

Ankle Sprains

A

If not properly managed, CAI can lead to…

  • Prolonged discomfort
  • Increased likelihood of recurrent injuries
  • Potential development of degenerative joint diseases due to ongoing instability and abnormal joint mechanics
31
Q

What is a syndesmotic ankle sprain, and how does it differ from other types of ankle sprains?

Ankle Sprains

A

A syndesmotic ankle sprain involves injury to the syndesmosis ligaments that connect the tibia and fibula above the ankle joint, differing from other sprains by affecting these high ankle ligaments rather than the more commonly injured lateral or medial ankle ligaments.

32
Q

Identify the key ligaments involved in a syndesmotic ankle sprain.

Ankle Sprains

A

Key ligaments include the

  • Anterior tibiofibular ligament (AITFL)
  • Posterior tibiofibular ligament
  • Interosseous membrane,
  • (sometimes) the Deltoid ligament
33
Q

Describe the common mechanism of injury for a syndesmotic ankle sprain.

Ankle Sprains

A

The common mechanisms of injury include…

  • External rotation of the foot
  • Hyperdorsiflexion combined w/ external rotation
  • Axial loading of the ankle.
34
Q

What sports are most commonly associated with syndesmotic ankle sprains?

Ankle Sprains

A

Sports commonly associated include football, hockey, wrestling, rugby, and lacrosse.

35
Q

List the primary symptoms of a syndesmotic ankle sprain.

Ankle Sprains

A
  • Anterior lateral ankle pain proximal to the AITFL
  • Medial sided ankle tenderness
  • Difficulty bearing weight
36
Q

Which special tests are used to diagnose a syndesmotic ankle sprain?

Ankle Sprains

A
37
Q

Why is it important to avoid dorsiflexion mobilizations in the early treatment of syndesmotic ankle sprains?

Ankle Sprains

A

Avoiding dorsiflexion mobilizations is important because they can increase the stress on the injured syndesmotic ligaments, potentially worsening the injury.

38
Q

Discuss the typical recovery timeline for syndesmotic ankle sprains compared to other ankle sprains.

Ankle Sprains

A

Recovery from syndesmotic ankle sprains is typically longer and more variable, often requiring twice the recovery time of standard lateral ankle sprains due to the complexity and severity of the ligament damage.

39
Q

What are some non-weight bearing strategies recommended during the initial phase of rehab for a syndesmotic ankle sprain?

Ankle Sprains

A

Initial rehab strategies include using crutches or other assistive devices to off-load weight from the ankle, combined with pain and inflammation management techniques.

40
Q

How does the rehabilitation progress for a syndesmotic ankle sprain?

Ankle Sprains

A

Rehabilitation progresses from non-weight bearing activities to gradual weight-bearing as pain allows, including flexibility and range of motion exercises, followed by strengthening and finally sports-specific drills.

41
Q

What is the role of surgical intervention in syndesmotic ankle sprains?

Ankle Sprains

A

Surgical intervention, such as the Ankle Tightrope procedure or Syndesmotic button procedure, may be considered in cases of severe instability or when non-operative management fails to stabilize the ankle.

42
Q

Explain how proprioception and balance exercises are incorporated into the rehabilitation of a syndesmotic ankle sprain.

Ankle Sprains

A

Proprioception and balance exercises, such as using a rocker board or Bosu ball, are critical in later stages of rehabilitation to restore ankle stability and prevent re-injury.

43
Q

What are common complications that can arise from inadequately treated syndesmotic ankle sprains?

Ankle Sprains

A

Common complications include prolonged instability, chronic pain, increased risk of re-injury, and potential development of osteoarthritis due to joint malalignment.

44
Q

Why is early and accurate diagnosis of syndesmotic ankle sprains critical?

Ankle Sprains

A

Early and accurate diagnosis is crucial to prevent complications and ensure appropriate treatment is initiated promptly, which significantly affects recovery outcomes.

45
Q

Describe how functional testing is used to determine readiness to return to activity after a syndesmotic ankle sprain.

Ankle Sprains

A

Functional testing may include activities that mimic the patient’s sport or daily activities, assessing the ankle’s response to stress and ensuring stability, strength, and pain-free mobility before full return to activity.

46
Q

What is ankle impingement and how is it classified?

Ankle Sprains

A

Ankle impingement refers to the pinching or compression of soft tissue or bone in the ankle, classified as either anterior or posterior impingement based on the location of the symptoms.

47
Q

Describe the common symptoms of anterior ankle impingement.

Ankle Sprains

A

Symptoms of anterior ankle impingement include pain at the front of the ankle, especially during activities that involve dorsiflexion, and a sensation of blocking or restriction in ankle movement.

48
Q

What are the typical causes of posterior ankle impingement?

Ankle Sprains

A

Posterior ankle impingement is typically caused by compression of soft tissues or bone structures at the back of the ankle, often due to repetitive forceful plantar flexion movements.

49
Q

Which activities are most likely to lead to ankle impingement?

Ankle Sprains

A

Activities that involve repetitive ankle movements, especially in extreme ranges of motion like dancing, soccer, and other high-impact sports, are most likely to lead to ankle impingement.

50
Q

How is ankle impingement diagnosed in a clinical setting?

Ankle Sprains

A

- Diagnosis often involves clinical examination tests like…

- Alongside imaging studies such as X-rays to identify bone abnormalities

51
Q

What are the treatment options for ankle impingement?

Ankle Sprains

A

Treatment may include rest, physical therapy focusing on ROM and strengthening exercises, anti-inflammatory medications, and in severe cases, surgical intervention to remove the impinging structures.

52
Q

Describe a typical physical therapy approach to managing anterior ankle impingement.

Ankle Sprains

A

Physical therapy may involve modalities to reduce inflammation, exercises to increase dorsiflexion range of motion, and strengthening exercises to support the ankle joint.

53
Q

What role does bracing or taping play in the management of ankle impingement?

Ankle Sprains

A

Bracing or taping can help stabilize the ankle, limit harmful ranges of motion, and provide support during the healing process or during activities that might exacerbate symptoms.

54
Q

Explain the implications of ankle impingement on long-term ankle health.

Ankle Sprains

A

If untreated, ankle impingement can lead to chronic pain, decreased range of motion, and potentially contribute to the development of osteoarthritis due to ongoing joint stress.

55
Q

What surgical options are available for severe cases of ankle impingement?

Ankle Sprains

A

Surgical options may include arthroscopic debridement to remove bone spurs or loose bodies, and resection of hypertrophied soft tissues that contribute to impingement.

56
Q

How does manual therapy assist in the treatment of ankle impingement?

Ankle Sprains

A

Manual therapy can help improve joint mobility, decrease pain, and facilitate better movement patterns through techniques such as joint mobilizations and soft tissue work.

57
Q

What preventive measures can be taken to avoid the occurrence of ankle impingement?

Ankle Sprains

A

Preventive measures include proper warm-up and stretching before activities, strength and flexibility training, using appropriate footwear, and avoiding repetitive stress on the ankle by modifying activity levels and techniques.

58
Q

What are the long-term outcomes of ankle sprains and how can continuous care impact these outcomes?

Ankle Sprains

A
  • Long-term outcomes can include chronic pain, repeated instability, and increased risk of osteoarthritis.
  • Continuous care, including adherence to a comprehensive rehabilitation program and preventive strategies, can mitigate these outcomes by enhancing joint stability, strength, and proprioception.
59
Q

Discuss the relationship between ankle sprains and knee injuries. What is the concept of “regional interdependence” in this context?

Ankle Sprains

A
  • The concept of “regional interdependence” suggests that injuries or dysfunction in one part of the body can affect other areas.
  • For example, ankle sprains can lead to altered gait patterns, which may increase the risk of knee injuries due to compensatory movements, highlighting the importance of a holistic approach to rehabilitation.
60
Q

How do acute and chronic ankle sprains differ in their clinical presentation and management strategies?

Ankle Sprains

A
  • Acute ankle sprains typically present with immediate pain, swelling, and bruising, managed initially with the PRICE protocol and gradual reintroduction of movement.
  • Chronic ankle sprains involve persistent instability and discomfort, requiring more extensive rehabilitation focused on strengthening and proprioceptive exercises to prevent recurrent sprains.
61
Q

Explain the importance of differential diagnosis in the management of ankle sprains. What other conditions should be considered?

Ankle Sprains

A
  • Accurate differential diagnosis is crucial to ensure appropriate treatment.
  • Conditions that may mimic or coexist with ankle sprains include fractures (e.g., confirmed by Ottawa Ankle Rules), tendinopathies, and other ligament injuries.
62
Q

Describe how rehabilitation techniques vary based on the type and severity of an ankle sprain.

Ankle Sprains

A

For mild sprains, rehabilitation might focus on quick restoration of movement and strengthening, while severe sprains might require prolonged immobilization, followed by a more gradual progression through therapeutic exercises and proprioceptive training to ensure full recovery.

63
Q

What are the long-term implications of not adequately rehabilitating a sprained ankle?

Ankle Sprains

A

Inadequate rehabilitation can lead to chronic ankle instability, recurrent sprains, decreased functionality, and potentially osteoarthritis due to ongoing joint stress and degradation.

64
Q

What are the common modalities used in the management of ankle sprains and their evidential support?

Ankle Sprains

A

Common modalities include cryotherapy and manual therapy, with cryotherapy supported by evidence for reducing pain and swelling, and manual therapy (e.g., joint mobilizations) having evidence for improving range of motion and decreasing pain.

65
Q

Explain the role of external supports in the prevention and management of ankle sprains.

Ankle Sprains

A

External supports, such as braces and taping, provide additional ankle stability during healing and when returning to activity, reducing the risk of re-injury by limiting excessive movements that could lead to sprains.

66
Q

What are the criteria for returning to sport after an ankle sprain?

Ankle Sprains

A

Criteria include minimal to no swelling, restored range of motion within 90% of the uninjured side, normalized gait, strength at level 5/5, and successful completion of functional testing such as hop tests and balance assessments.

67
Q

Discuss the progression of weight-bearing activities during ankle sprain rehabilitation.

Ankle Sprains

A

Rehabilitation progresses from non-weight-bearing exercises to partial and then full weight-bearing as tolerated, based on pain levels and healing progress, to gradually restore normal function.

68
Q

What is the importance of proprioceptive training in the rehabilitation of ankle sprains?

Ankle Sprains

A

Proprioceptive training is vital to re-educate the ankle’s sense of position and movement, helping to prevent instability and recurrent sprains by improving balance and neuromuscular control.

69
Q

How does therapeutic exercise contribute to the recovery from an ankle sprain?

Ankle Sprains

A

Therapeutic exercises help restore range of motion, improve muscle strength and coordination, and enhance proprioception, which are crucial for the stability and function of the ankle post-injury.

70
Q

Progression of Lateral Ankle Sprain

  • Acute Phase =?
  • Sub-Acute Phase =?
  • Maturation Phase =?

Ankle Sprains

A

- Acute Phase:

  • Cryotherapy/compression
  • Manual therapy
  • Mobilization
  • ROM/Stretching
  • Stationary bike

- Sub-Acute Phase:

  • Massage to improve lymph drainage
  • Joint mobs/exercises
  • Box step ups
  • Weight shifts
  • Resistance bands
  • Lunges
  • Wobble board

- Maturation Phase: Higher level balance exercises =

  • Ball toss on foam
  • Ball toss to trampoline on foam
  • Hopping
  • Figure 8’s running
  • Cutting at 45 degree angles
  • Box jumps
71
Q

Describe the initial management strategies for an acute ankle sprain.

Ankle Sprains

A

Initial management includes the PRICE protocol (Protection, Rest, Ice, Compression, Elevation), immobilization if necessary, and pain management strategies to reduce swelling and discomfort.

72
Q

What are the primary goals of rehabilitation following an ankle sprain?

Ankle Sprains

A

The primary goals of rehabilitation are to reduce pain and swelling, restore full range of motion, strengthen the ankle to prevent future sprains, and return the individual to their normal activities or sports.

DPT 691 - MSK II (20 decks)

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