W2: THE PROBLEM ANKLE Flashcards
What are the functional and mechanical impairments in the Chronic Ankle Instability?
Functional:
Reduced proprioception
Reduced neuromuscular control
Poor postural control
Impaired strength
Mechanical:
Pathological laxity
Impingements
Osteochondral damage (defect of the articular cartilage and bone)
degenerative damage
What kind of symptoms do we see in Chronic Ankle Instability?
- Feeling of Instability
- Unable to perform normal sport
- Giving way
- Recurrent ankle sprains
+/- Pain on dorsiflexion
Weakness and lack of proprioception
Anterior drawer
How should we assess for functional and mechanical instability for Chronic ankle instability
functional: Cumberland Ankle Instability Tool (CAIT), Star Excursion Balance Test (SEBT)
Mechanical: Anterior Drawer Test, Imaging
How do we manage Chronic Ankle Instability (CAI)?
Weeks to months of comprehensive/intensive rehabilitation program.
- Exercise therapy, Manual, therapy, braciing (Prevnting recurrence), taping (inconclusive but some suggest it more effextive than bracing), Modified footwear (inconclusive), Orthotics (lacks evidence)
Note that bracing ankle is the first thing that should be done.. Taping could be used in the transition phase when the athlete is trying to get back into the sport.
WARNING: If the injury is a grade 3 and has failed rehab, surgery may be needed –> Tendon reconstruction, Bronstrom procedure, Use of free autograft or allograft tendon.
HOWEVER always consider rehab first and also whether the sport of return is likely to be needing the surgery.
What are the signs and symptoms and management strategies for loose bodies in a Chronic Ankle instability?
Signs and Symptoms: Pain during dorsiflexion then weight-bearing, locking
Conservative Management: Accessory mobilisation/orthotics/avoid excessive DF/Strengthening and proprioceptive exercises
Surgical management: Arthroscopy
What are the mechanism of injury, signs and symptoms and management strategies for osteophytes (anterior impingement) in a Chronic Ankle instability?
MOI: Repeated ankle DF, Degenerative changes,
Signs and Symptoms: Pain during dorsiflexion when weight-bearing
Conservative Management: Accessory mobilisation/orthotics/avoid excessive DF/Strengthening and proprioceptive exercises.
Surgical management
What are the mechanism of injury, signs and symptoms and management strategies for osteophytes (anterior impingement) in a Chronic Ankle instability?
MOI: Occurs following a lateral ankle sprain
Signs and Symptoms: Pain during flexion
Conservative Management: Accessory mobilisation/orthotics/avoid excessive DF/Strengthening and proprioceptive exercises.
Corticosteroid injection
Surgical management
What are the mechanism of injury, signs and symptoms and management strategies for Chronic Synovitis in a Chronic Ankle instability?
MOI:
Following CAI
Following aggressive rehab
Signs and symptoms:
Anterior pain during dorsiflexion when weight-bearing
Conservative Management:
Appropriate rehabilitation
Strengthening and proprioceptive exercises
Medical Intervention:
Ultrasound guided corticosteroid injection
What are the mechanism of injury, signs and symptoms, diagnosis method and management for Osteochondral injuries in a Chronic Ankle instability?
MOI:
Common after ankle sprains
Jumping from a height or high-speed running
Signs and symptoms:
Usually diagnosed late following persistent pain, stiffness and locking.
Diagnosis: CT and MRI
Rx: depends on grade of injury whether it’s conservative or operative.
What are the long term prognosis of a poorly rehabilitated ankle
Fear Avoidance, Disengagement in sport and physical activity, Weight gain (Gribble et al), Poor physical and mental healt (Gribble et al), and Osteoarthritis
What are the standing and on the plinth (medical chair) assessment methods for the ankle and foot)
Standing: Weight bearing status, Proprioception, Biomechanics, Functional stress, Flexibility, DoF whilst standing
Plinth: active and passive ROM, palpation, anterior drawer test, Resisted muscle test, accessory movements
What factors or variable can effect the decision making and programming of rehabilitation?
The person themself, musculoskeletal system, social factors, training related variable, general health, exercise progression variables, psychological factors.
