History
– How did it happen? – Where does it hurt? – Did the pain make you stop playing? – Were you able to bear weight right away? – Have you injured this or the other ankle before?
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Assessment Of Ankle Sprain
Physical Exam
– Strength testing (compare to other ankle) – Special tests for joint stability
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Assessment Of Ankle Sprain
swelling or ecchymosis – Move the ankle through six ranges of motion:
Plantar flexion, dorsiflexion, and inversion and eversion in plantar flexion and dorsiflexion
On-Field Management
“Golden Period”
– Best opportunity for accurate diagnosis – No swelling – Pain has subsided – No guarding
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Assessment Of Ankle Sprain
Talar Mortise
– Allows for plantar flexion and dorsiflexion
Subtalar Joint – Allows for inversion, eversion, and
internal and external rotation
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Assessment Of Ankle Sprain
Physical Exam
– Removal of shoes and socks on both feet – Examine uninjured ankle first – Palpate ligaments and bones and note any
Lateral Complex
– Anterior Talofibular* – Calcaneaofibular – Posterior Talofibular
Resists internal rotation, anterior displacement, and inversion
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Limits eversion Limits lateral displacement of the talus
– Medial malleolus will often fracture before this ligament tears*
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Ligamentous Structures Of The Ankle
Goal--Identify serious injury
– Screen for deformities
Axial traction and relocation
– Neurovascular assessment – Weight bearing – Stabilization
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精选ppt课件2源自Risk Of Ankle Injuries By Sport
Basketball---- 45% Soccer-------- 31% Volleyball--- 25% Football------ 10 - 15%
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Ankle Consists Of Two Joints
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Secondary Stabilizers
Muscles and Tendons
– Peroneous Longus – Anterior Tibialis – Posterior Tibialis – Achilles tendon
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On-Field Management
Specific Tests
– Anterior Drawer Test
Assesses the integrity of the anterior talofibular ligament Large number of false negatives is assessed within the first 48 hours 4 - 5 days postinjury has a sensitivity of 86% and specitivity of 74%
Assessment And Management Of Ankle Sprains
Steven Schepens M.D.
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Ankle Sprains
Most common athletic injury Most caused by excessive inversion – Injury to lateral supporting ligament Most treated nonoperatively
– Stabilizes the ankle mortise – Allows little movement between tibia and
fibula
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Ligamentous Structures Of The Ankle
Medial Complex
– Deltoid Ligament
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Ligamentous Structures Of The Ankle
1) Tibiofibular Complex 2) Medial Complex 3) Lateral Complex
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Ligamentous Structures Of The Ankle
Tibiofibular Complex