踝关节扭伤的评价和处理

1、Assessment And Management Of Ankle Sprains Steven Schepens M.D. Ankle Sprains nMost common athletic injury nMost caused by excessive inversion Injury to lateral supporting ligament nMost treated nonoperatively Risk Of Ankle Injuries By Sport nBasketball- 45% nSoccer- 31% nVolleyball- 25% nFootball-

2、10 - 15% Ankle Consists Of Two Joints nTalar Mortise Allows for plantar flexion and dorsiflexion nSubtalar Joint Allows for inversion, eversion, and internal and external rotation Ligamentous Structures Of The Ankle n1) Tibiofibular Complex n2) Medial Complex n3) Lateral Complex Ligamentous Structur

3、es Of The Ankle nTibiofibular Complex Stabilizes the ankle mortise Allows little movement between tibia and fibula Ligamentous Structures Of The Ankle nMedial Complex Deltoid Ligament nLimits eversion nLimits lateral displacement of the talus Medial malleolus will often fracture before this ligament

4、 tears* Ligamentous Structures Of The Ankle nLateral Complex Anterior Talofibular* Calcaneaofibular Posterior Talofibular nResists internal rotation, anterior displacement, and inversion Secondary Stabilizers nMuscles and Tendons Peroneous Longus Anterior Tibialis Posterior Tibialis Achilles tendon

5、On-Field Management nGoal-Identify serious injury Screen for deformities nAxial traction and relocation Neurovascular assessment Weight bearing Stabilization On-Field Management n“Golden Period” Best opportunity for accurate diagnosis No swelling Pain has subsided No guarding Assessment Of Ankle Spr

6、ain nHistory 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? Assessment Of Ankle Sprain nPhysical Exam Removal of shoes and socks on both feet Examine uninjured ankle first Palpate li

7、gaments and bones and note any swelling or ecchymosis Move the ankle through six ranges of motion: nPlantar flexion, dorsiflexion, and inversion and eversion in plantar flexion and dorsiflexion Assessment Of Ankle Sprain nPhysical Exam Strength testing (compare to other ankle) Special tests for join

8、t stability Assessment Of Ankle Sprain nSpecific Tests Anterior Drawer Test nAssesses the integrity of the anterior talofibular ligament nLarge number of false negatives is assessed within the first 48 hours n4 - 5 days postinjury has a sensitivity of 86% and specitivity of 74% Assessment Of Ankle S

9、prain nSpecific Tests Talar Tilt Test nDeltoid ligament- eversion nCalcaneofibular- inversion Side-to-side Test nTibiofibular ligament 93% specific Assessment Of Ankle Sprain nSpecific Tests Thompsons Test nAchilles tendon Squeeze Test External Rotation Test nSyndesmosis injuries Assessment Of Ankle

10、 Sprain nRadiographs Ottawa Ankle Rules* When are ankle X-rays necessary: nInability to bear weight nBone tenderness on the tip of either malleolus or up to 6cm up the posterior edge Assessment Of Ankle Sprain nRadiographs Ottawa Ankle Rules* When are foot X-rays necessary: nInability to bear weight

11、 nBone tenderness at the navicular or the base of the fifth metatarsal n100% sensitivity Ankle Injury Differential nLateral Inversion Sprain Most common injury 85% of all ankle sprains Lateral ligaments damaged from anterior to posterior Grading Lateral Ankle Sprains GradeAnt.Drawer Test Talar Tilt

12、Test Return to Play 1NegativeNegative1 10 days 2Increased Laxity Negative2- 4 weeks 3PositivePositive5 8 wk with rehab. Mnemonic for Treating Ankle Sprains nP-rotection nR-est nI-ce nC-ompression nE-levation nM-edication nM-obilization Medial Eversion Sprain nCommonly seen in wrestlers n10% of sprai

13、ns vs. 85% lateral n75% of ankle fractures occur on medial side nDeltoid Ligament Syndesmosis Sprain n1% - 11% of ankle sprains nExternal rotation stress radiographs nLittle swelling nRecovery time of 55 days Bifurcate Ligament Injury nInjury Violent Dorsiflexion, Forceful plantar flexion, direct tr

14、auma n19% of inversion sprains nAvulsion of anterior process of calcaneous nNon-weight-bearing cast for four weeks ACHILLES TENDON RUPTURE nRapid plantar flexion n2 to 6cm above the Os Calcis Peroneal Tendon Injury nSubluxation or dislocation nPalpate over the tendon with dorsiflexion and eversion Flexor Hallucis Longus Injury nOccurs with people who tiptoe or stand on the balls of their feet Lateral Periostitis nJumpers ankle nS