踝关节扭伤的评价和处理

Assessment And Management Of Ankle Sprains,Steven Schepens M.D.,Ankle Sprains,Most common athletic injuryMost caused by excessive inversionInjury to lateral supporting ligamentMost treated nonoperatively,Risk Of Ankle Injuries By Sport,Basketball- 45%Soccer- 31%Volleyball- 25%Football- 10 - 15%,Ankle Consists Of Two Joints,Talar MortiseAllows for plantar flexion and dorsiflexionSubtalar JointAllows for inversion, eversion, and internal and external rotation,Ligamentous Structures Of The Ankle,1) Tibiofibular Complex2) Medial Complex3) Lateral Complex,Ligamentous Structures Of The Ankle,Tibiofibular ComplexStabilizes the ankle mortiseAllows little movement between tibia and fibula,Ligamentous Structures Of The Ankle,Medial ComplexDeltoid LigamentLimits eversionLimits lateral displacement of the talusMedial malleolus will often fracture before this ligament tears*,Ligamentous Structures Of The Ankle,Lateral ComplexAnterior Talofibular*CalcaneaofibularPosterior TalofibularResists internal rotation, anterior displacement, and inversion,Secondary Stabilizers,Muscles and TendonsPeroneous LongusAnterior TibialisPosterior TibialisAchilles tendon,On-Field Management,Goal-Identify serious injuryScreen for deformitiesAxial traction and relocationNeurovascular assessment Weight bearingStabilization,On-Field Management,“Golden Period”Best opportunity for accurate diagnosisNo swelling Pain has subsidedNo guarding,Assessment Of Ankle Sprain,HistoryHow 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?,Assessment Of Ankle Sprain,Physical ExamRemoval of shoes and socks on both feetExamine uninjured ankle firstPalpate ligaments and bones and note any swelling or ecchymosisMove the ankle through six ranges of motion:Plantar flexion, dorsiflexion, and inversion and eversion in plantar flexion and dorsiflexion,Assessment Of Ankle Sprain,Physical ExamStrength testing (compare to other ankle)Special tests for joint stability,Assessment Of Ankle Sprain,Specific TestsAnterior Drawer TestAssesses the integrity of the anterior talofibular ligamentLarge number of false negatives is assessed within the first 48 hours4 - 5 days postinjury has a sensitivity of 86% and specitivity of 74%,Assessment Of Ankle Sprain,Specific TestsTalar Tilt TestDeltoid ligament- eversionCalcaneofibular- inversionSide-to-side TestTibiofibular ligament93% specific,Assessment Of Ankle Sprain,Specific TestsThompsons TestAchilles tendonSqueeze TestExternal Rotation TestSyndesmosis injuries,Assessment Of Ankle Sprain,RadiographsOttawa Ankle Rules*When are ankle X-rays necessary:Inability to bear weightBone tenderness on the tip of either malleolus or up to 6cm up the posterior edge,Assessment Of Ankle Sprain,RadiographsOttawa Ankle Rules*When are foot X-rays necessary:Inability to bear weightBone tenderness at the navicular or the base of the fifth metatarsal100% sensitivity,Ankle Injury Differential,Lateral Inversion SprainMost common injury85% of all ankle sprainsLateral ligaments damaged from anterior to posterior,Grading Lateral Ankle Sprains,Mnemonic for Treating Ankle Sprains,P-rotectionR-estI-ceC-ompressionE-levationM-edicationM-obilization,Medial Eversion Sprain,Commonly seen in wrestlers10% of sprains vs. 85% lateral75% of ankle fractures occur on medial sideDeltoid Ligament,Syndesmosis Sprain,1% - 11% of ankle sprainsExternal rotation stress radiographsLittle swellingRecovery time of 55 days,Bifurcate Ligament Injury,InjuryViolent Dorsiflexion, Forceful plantar flexion, direct trauma19% of inversion sprainsAvulsion of anterior process of calcaneousNon-weight-bearing cast for four weeks,ACHILLES TENDON RUPTURE,Rapid plantar flexion2 to 6cm above the Os Calcis,Peroneal Tendon Injury,Subluxation or dislocationPalpate over the tendon with dorsiflexion and eversion,Flexor Hallucis Longus Injury,Occurs with people who tiptoe or stand on the balls of their feet,Lateral Periostitis,Jumpers ankleSympto