踝关节损伤的诊治幻灯.ppt

1、Assessment And Management Of Ankle Sprains,Steven Schepens M.D.,Ankle Sprains,Most common athletic injury Most caused by excessive inversion Injury to lateral supporting ligament Most treated nonoperatively,Risk Of Ankle Injuries By Sport,Basketball- 45% Soccer- 31% Volleyball- 25% Football- 10 - 15

2、%,Ankle Consists Of Two Joints,Talar Mortise Allows for plantar flexion and dorsiflexion Subtalar Joint Allows for inversion, eversion, and internal and external rotation,Ligamentous Structures Of The Ankle,1) Tibiofibular Complex 2) Medial Complex 3) Lateral Complex,Ligamentous Structures Of The An

3、kle,Tibiofibular Complex Stabilizes the ankle mortise Allows little movement between tibia and fibula,Ligamentous Structures Of The Ankle,Medial Complex Deltoid Ligament Limits eversion Limits lateral displacement of the talus Medial malleolus will often fracture before this ligament tears*,Ligament

4、ous Structures Of The Ankle,Lateral Complex Anterior Talofibular* Calcaneaofibular Posterior Talofibular Resists internal rotation, anterior displacement, and inversion,Secondary Stabilizers,Muscles and Tendons Peroneous Longus Anterior Tibialis Posterior Tibialis Achilles tendon,On-Field Management

5、,Goal-Identify serious injury Screen for deformities Axial traction and relocation Neurovascular assessment Weight bearing Stabilization,On-Field Management,“Golden Period” Best opportunity for accurate diagnosis No swelling Pain has subsided No guarding,Assessment Of Ankle Sprain,History How did it

6、 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 Exam Removal of shoes and socks on both feet Examine uninjured ankle first Palpate ligaments and bones and no

7、te any swelling or ecchymosis Move the ankle through six ranges of motion: Plantar flexion, dorsiflexion, and inversion and eversion in plantar flexion and dorsiflexion,Assessment Of Ankle Sprain,Physical Exam Strength testing (compare to other ankle) Special tests for joint stability,Assessment Of

8、Ankle Sprain,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 Of Ankle Sprain,Specific Tests Talar Til

9、t Test Deltoid ligament- eversion Calcaneofibular- inversion Side-to-side Test Tibiofibular ligament 93% specific,Assessment Of Ankle Sprain,Specific Tests Thompsons Test Achilles tendon Squeeze Test External Rotation Test Syndesmosis injuries,Assessment Of Ankle Sprain,Radiographs Ottawa Ankle Rule

10、s* When are ankle X-rays necessary: Inability to bear weight Bone tenderness on the tip of either malleolus or up to 6cm up the posterior edge,Assessment Of Ankle Sprain,Radiographs Ottawa Ankle Rules* When are foot X-rays necessary: Inability to bear weight Bone tenderness at the navicular or the b

11、ase of the fifth metatarsal 100% sensitivity,Ankle Injury Differential,Lateral Inversion Sprain Most common injury 85% of all ankle sprains Lateral ligaments damaged from anterior to posterior,Grading Lateral Ankle Sprains,Mnemonic for Treating Ankle Sprains,P-rotection R-est I-ce C-ompression E-lev

12、ation M-edication M-obilization,Medial Eversion Sprain,Commonly seen in wrestlers 10% of sprains vs. 85% lateral 75% of ankle fractures occur on medial side Deltoid Ligament,Syndesmosis Sprain,1% - 11% of ankle sprains External rotation stress radiographs Little swelling Recovery time of 55 days,Bif

13、urcate Ligament Injury,Injury Violent Dorsiflexion, Forceful plantar flexion, direct trauma 19% of inversion sprains Avulsion of anterior process of calcaneous Non-weight-bearing cast for four weeks,ACHILLES TENDON RUPTURE,Rapid plantar flexion 2 to 6cm above the Os Calcis,Peroneal Tendon Injury,Subluxation or dislocation Palpate 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 ankle Sympto